切开复位锁定钢板内固定术与半肩关节置换术治疗复杂肱骨近端骨折疗效比较的回顾性分析

摘要 目的：对比半肩关节置换术、切开复位锁定钢板内固定术两种术式治疗复杂肱骨近端骨折的疗效。方法：回顾性分析2019年3月~2021年3月期间四川省人民医院收治的92例复杂肱骨近端骨折患者的临床资料。根据手术方案，将92例患者区分为A组（n=44，切开复位锁定钢板内固定术治疗）和B组（n=48，半肩关节置换术治疗）。对比两组围术期指标、疼痛和肩关节功能相关评分、血清应激因子水平及术后并发症发生率。结果：两组手术时间、术中出血量组间对比未见统计学差异（P>0.05）。术后6个月，两组Constant-Murley评分、Neer评分均升高，视觉疼痛模拟评分（VAS）评分均下降（P<0.05），但两组上述评分组间对比无统计学差异（P>0.05）。术后7 d，两组皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E）水平均升高，但B组上述指标水平均低于A组（P<0.05）。B组的术后并发症发生率低于A组（P<0.05）。结论：半肩关节置换术治疗复杂肱骨近端骨折，可获得与切开复位锁定钢板内固定术治疗大致相当的临床疗效，但半肩关节置换术术后应激反应更小，并发症发生率更低，具有一定优势。

Retrospective Analysis of Efficacy Comparison of Open Reduction and Locking Plate Internal Fixation and Half Shoulder Arthroplasty in the Treatment of Complex Proximal Humeral Fractures

ABSTRACT Objective: To compare the efficacy of half shoulder arthroplasty and open reduction and locking plate internal fixation in the treatment of complex proximal humeral fractures. Methods: 92 patients with complex proximal humeral fractures who were treated in Sichuan Provincial People''s Hospital from March 2019 to March 2021 were selected by retrospective analysis. According to the operation plan, 92 patients were divided into group A (n=44, open reduction and locking plate internal fixation) and group B (n=48, half shoulder arthroplasty). The perioperative indexes, pain and shoulder function related scores, the level of serum stress factors and the incidence of postoperative complications were compared between the two groups. Results: There were no significant differences in operation time and intraoperative blood loss between the two groups (P>0.05). 6 months after operation, the Constant-Murley score and Neer score in the two groups increased, and the visual pain simulation score (VAS) decreased (P<0.05), but there was no significant difference in above scores between the two groups (P>0.05). 7 d after operation, the levels of cortisol (Cor), norepinephrine (NE) and epinephrine (E) in the two groups increased, but the levels of the above indexes in group B were lower than those in group A (P<0.05). The incidence of postoperative complications in group B was lower than that in group A (P<0.05). Conclusion: Half shoulder arthroplasty in the treatment of complex proximal humeral fractures can obtain roughly the same clinical effect as open reduction and locking plate internal fixation, but half shoulder arthroplasty has less stress response and lower incidence of complications, and it has a certain advantage.