摘要
目的探讨肩袖修补术治疗肱骨近端骨折的疗效与年龄、Neer分型的相关性。方法于武警海警总队医院病历数据库中收集2020年1月至2023年1月行肩袖修补术的肱骨近端骨折患者90例的临床资料进行回顾性分析,根据年龄分布分为1组(>18~<30岁,n=10)、2组(≥30~<45岁,n=15)、3组(≥45~<60岁,n=40)、4组(>60岁,n=25),四组基线资料差异均无统计学意义(均P>0.05),有可比性;按Neer分型分为Ⅰ组(NeerⅡ型,n=28)、Ⅱ组(NeerⅢ型,n=30)、Ⅲ组(NeerⅣ型,n=32)。记录对比不同年龄、Neer分型的疗效相关评估指标的差异,疗效相关指标包括手术时间、术中出血量、骨折愈合时间、视觉模拟评分法(VAS)评分、Constant-Murley评分、Neer肩关节功能评分,根据Neer标准评估总体疗效:>90分为优,80~89分为良,70~79分为可,<70分为差。观察比较各组术后并发症总发生率。结果术后6个月,临床治疗总体有效率为95.56%(86/90);术后2周,VAS评分较术前低为(3.45±1.35)分(P<0.05);术后6个月,Constant-Murley评分、Neer肩关节功能评分较术前高,分别为(90.34±6.34)分、(86.34±5.46)分(P<0.05)。四组的骨折愈合时间(F=4.89,P<0.05)、术中出血量(F=5.28,P<0.05)、VAS评分(F=5.02,P<0.05)、Neer肩关节功能评分(F=5.32,P<0.05)、Constant-Murley评分(F=3.85,P<0.05)差异均有统计学意义。1组、2组、3组、4组术后并发症总发生率、手术时间比较差异无统计学意义[0比5.00%(2/40)比6.67%(1/15)比12.00%(3/25),χ^(2)=0.98,P>0.05]。Ⅲ组的手术时间、骨折愈合时间长于Ⅰ组、Ⅱ组(F=4.55、4.23,均P<0.05),术中出血量多于Ⅰ组、Ⅱ组(F=5.24,P<0.05),VAS评分高于Ⅰ组、Ⅱ组(F=5.06,P<0.05),Neer肩关节功能评分、Constant-Murley评分低于Ⅰ组、Ⅱ组(F=3.83、4.56,均P<0.05)。Ⅰ组、Ⅱ组、Ⅲ组术后并发症总发生率比较差异无统计学意义[9.38%(3/32)比3.57%(1/28)比6.67%(2/30),χ^(2)=1.00,P>0.05]。Pearson相关分析结果显示,年龄、Neer分型与术中出血量、骨折愈合时间、VAS评分呈正相关(r=0.565,P<0.05),与Neer肩关节功能评分呈负相关(r=-0.620,P<0.05);年龄、Neer分型与Constant-Murley评分无相关性(r=-0.008,P>0.05)。结论肩袖修补术治疗肱骨近端骨折患者的疗效佳,但在不同的年龄和Neer分型中疗效显现差异,其年龄、Neer分型与术中出血量、骨折愈合时间、VAS评分呈正相关,与Neer肩关节功能评分呈负相关。
Objective To investigate the effectiveness of rotator cuff repair surgery in treating proximal humeral fractures and its association with patient age and Neer classification.Methods A retrospective analysis was conducted on the clinical data of 90 patients with proximal humeral fractures who underwent rotator cuff repair surgery at the Marine Police Corps Hospital of the Chinese People's Armed Police Force between January 2020 and January 2023.The clinical data of these patients were retrieved from the hospital's medical record database.Based on the age distribution of the patients,they were divided into four groups:Group 1(>18 years old and<30 years old,n=10),Group 2(≥30 years old and<45 years old,n=15),Group 3(≥45 years old and<60 years old,n=40),and Group 4(>60 years old,n=25).There were no statistically significant differences in baseline data among the four groups(all P>0.05),indicating comparability.Additionally,these patients were divided into three groups based on Neer classification:Group I(Neer type II,n=28),Group II(Neer type III,n=30),and Group III(Neer type IV,n=32).Differences in various outcome measures related to treatment efficacy,including operation time,intraoperative blood loss,fracture healing time,Visual Analogue Scale(VAS)score,Constant-Murley score,Neer shoulder function score,and the overall incidence of postoperative complications,were recorded and compared across different age groups.Overall efficacy was assessed according to the Neer criteria:>90 points as excellent,80-89 as good,70-79 as fair,and<70 as poor.Results After 6 months of surgery,the overall clinical treatment effectiveness rate was 95.56%(86/90).At 2 weeks postoperatively,the VAS score was(3.45±1.35)points,which was significantly decreased compared with the level measured preoperatively(P<0.05).At 6 months postoperatively,the Constant-Murley score and Neer shoulder function score were(90.34±6.34)points and(86.34±5.46)points,respectively(both P<0.05),which were significantly increased compared with the levels measured preoperatively.There were significant differences in fracture healing time(F=4.89,P<0.05),intraoperative blood loss(F=5.28,P<0.05),VAS score(F=5.02,P<0.05),and Neer shoulder function score(F=5.32,P<0.05)and Constant-Murley scores(F=3.85,P<0.05)compared with before treatment.There was no statistically significant difference in the overall incidence of postoperative complications or surgical time among Groups 1,2,3,and 4[0 vs.5.00%(2/40)vs.6.67%(1/15)vs.12.00%(3/25),χ^(2)=0.98,P>0.05].Group III had longer surgical time and fracture healing time compared with Groups I and II(F=4.55,4.23,both P<0.05),with greater intraoperative blood loss(F=5.24,both P<0.05).Additionally,Group III had a higher VAS score compared with Groups I and II(F=5.06,P<0.05),while the Neer shoulder joint function score and Constant-Murley score in Group III were lower(F=3.83,4.56,both P<0.05).There was no statistically significant difference in the overall incidence of postoperative complications among the Groups I,II,and III[9.38%(3/32)vs.3.57%(1/28)vs.6.67%(2/30),χ^(2)=1.00,all P>0.05].Pearson correlation analysis revealed a positive correlation between patient age,Neer classification,intraoperative blood loss,fracture healing time,and VAS score(r=0.565,all P<0.05),and a negative correlation with the Neer shoulder joint function score(r=-0.620,P<0.05).However,there was no significant correlation between patient age,Neer classification,and the Constant-Murley score(r=-0.008,P>0.05).Conclusion The rotator cuff repair is effective in treating proximal humeral fractures,but the effectiveness varies depending on patient age and Neer classification.Patient age and Neer classification are positively correlated with intraoperative blood loss,fracture healing time,and VAS score,while they are negatively correlated with the Neer shoulder joint function score.
作者
袁浩
程永刚
蔡执中
Yuan Hao;Cheng Yonggang;Cai Zhizhong(Department of Orthopedics,Marine Police Corps Hospital of Chinese People's Armed Police Force,Jiaxing 314000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2024年第5期668-674,共7页
Chinese Journal of Primary Medicine and Pharmacy
关键词
肱骨骨折
外科手术
肩关节
出血
骨折愈合
年龄因素
手术后并发症
Humeral fractures
Surgical procedures,operative
Shoulder joint
Hemorrhage
Fracture healing
Age factors
Postoperative complications
