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目的：探讨人工半肩关节置换治疗肱骨近端粉粹骨折的疗效及其影响因素。方法：选择2010 年1 月-2013 年12 月间我院收治的肱骨近端粉粹骨折患者80 例，随机分为研究组和对照组，每组40 例，研究组应用人工半肩关节置换治疗，对照组应用切开复位内固定治疗。对比两组的术中情况、术后疼痛强度以及不良情况发生情况，术后应用Constant-Murlay评分评价两组肩关节功能。应用多因素Logistic 回归分析分析疗效影响因素。结果：研究组手术时间、术中出血量均显著低于对照组(P<0.05)；研究组 Constant-Murlay 中疼痛、ADL、ROM 和总分评分显著优于对照组(P<0.05)；手术前，两组患者VAS 评分无统计学差异（P＞0.05），手术后两组患者VAS 评分显著降低，术后5 d、15 d、30 d和60 d，研究组VAS 评分显著低于对照组（P＜0.05）；对照组患者肌力不足、异位骨化等不良反应发生率显著高于对照组（P＜0.05）。以Constant-Murlay 总分为因变量，以年龄、性别、是否合并内科疾病、受伤原因、骨折分型、受伤时间为自变量，经Logistic 分析显示，年龄、合并内科疾病、骨折分型、受伤时间是肱骨近端粉碎性骨折疗效的影响因素（P<0.05）。结论：人工半肩关节置换治疗肱骨近端粉粹骨折安全有效，具有很高的临床价值，值得临床推广，同时在手术中应对影响疗效的因素予以注意，提高治疗效果。

英文摘要:

Objective:To explore the effects and the influencing factors of hemiarthroplasty for proximal humeral splintered fracture.Methods:80 cases of proximal humeral splintered fracture patients administered in our hospital between January 2010 and December 2013 were selected and randomly divided into the study group and the control group, 40 cases were in each group. The study group used artificial semi shoulder joint replacement therapy, while the control group was treated with open reduction and internal fixation. Degree of pain, postoperative adverse circumstances were compared. Constant-Murlay score was used to evaluate the postoperative shoulder joint function. Multiple factor Logistic regression analysis was used to evaluate the factors influencing the efficacy.Results:The amount of bleeding, operation time of study group were significantly lower and shorter than those of the control group (P<0.05). According to the Constant-Murlay scores, ADL, ROMand pain scores of the study group were significantly better than those of the control group (P<0.05). Before operation, the VAS scores of the two groups showed no significant difference (P>0.05), Afrer operation, VAS score decreased significantly, after 5 d, 15 d, 30 d and 60 d, VAS scores of the study group were significantly lower than those of the control group (P<0.05). More adverse reactions, including insufficient muscle strength and heterotopic ossification, were observed in the study group than in the control group (P<0.05). With Constant-Murlay score as the dependent variable, age, sex, complicated internal medicine diseases, cause of injury, fracture type, injured time as variables, the Logistic analysis showed that such items as age, internal medicine diseases, fracture type and injury time were the influencing factors of proximal comminuted fracture of humerus (P<0.05).Conclusion:Hemiarthroplasty for proximal humeral splintered is safety and effective, and is of high clinical value, which worth the clinical promotion. At the same time, for improving the therapeutic effect, the influencing factors should be paid attention to.

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