人工肱骨头置换术治疗肱骨近端Neer四部分骨折的效果分析(1)
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[摘要] 目的 探讨人工肱骨头置换术在Neer 4部分肱骨近端骨折中的治疗价值。 方法 将我院近5年来收治的11例Neer 4部分肱骨近端骨折患者采用人工肱骨头置换术治疗，并与同期采用锁定钢板治疗8例类似患者作比较，采用Neer疗效评分系统评价疗效。 结果 人工肱骨头置换的11例患者均能完成主动穿衣、梳头、系腰带、摸背等日常生活动作。疗效优4例、良5例、可2例、差0例，优良率为81.8%。随访中未发现神经损伤、伤口感染、假体松动及肩部肌肉明显萎缩等严重并发症产生，仅有2例主诉偶有肩痛或侧卧时患肩疼痛。而8例采用锁定钢板治疗的患者的疗效分别为优0例、良3例、可3例、差2例，优良率为37.5%，两组比较差异有统计学意义(χ2=3.910， P = 0.048)；而Neer总评分肱骨头置换组明显高于锁定钢板组(t = 5.200，P = 0.000)；8例采用锁定钢板治疗患者出现2例肱骨头无菌性坏死，1例伤口不愈合，其并发症发生率37.5%，明显高于肱骨头置换组(χ2=4.898， P = 0.027)。 结论 人工肱骨头置换术治疗肱骨近端四部分骨折疗效确切，术后并发症少，且疗效优于锁定钢板治疗者。
[关键词] 肱骨骨折；人工肱骨头置换术；Neer分型；Neer评分
[中图分类号] R683.41 [文献标识码] B [文章编号] 1673-9701(2012)03-0143-03
The therapeutic effect analysis of humeral head replacement for Neer four-part proximal humerus fractures
LU Xiaozhen
Department of Emergency, the Second Hospital of Ningbo City in Zhejiang Province，Ningbo 315010，China
[Abstract] Objective To investigate the therapeutic effect of humeral head replacement for Neer 4 part proximal humeral fractures. Methods In the last 5 years， 11 patients with Neer 4 part proximal humerus fractures were treated with humeral head replacement，and 8 patients of the same situation were treated with locking plate. We used the Neer scoring system to evaluate the therapeutic effect. Results All of 11 patients treated by humeral head replacement could complete dress，hair， belt line，touch back and other daily activities. Effects were excellent in 4 cases， good in 5 cases，common in 2 cases，poor in 0 case，overall satisfactory rate was 81.8%. After at least 6 months follow-up，there was no nerve damage，no wound infection，no implant loosening， no shoulder atrophy muscles and no other serious complications，only 2 patients complained of occasional back pain or side pain when suffering from shoulder.The effects in eight patients treated with locking plate were excellent in 0 cases，good in 3 cases，common in 3 cases and poor in 2 cases ......
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