307例肱骨近端骨折的临床特点分析

Clinical characteristics of 307 cases of proximal humeral fractures

目的通过多中心回顾性研究分析肱骨近端骨折患者的临床特点。方法对2002年7月至2009年9月国内5所大学附属医院收治且．获得完整随访的307例肱骨近端骨折患者资料进行回顾性分析，男140例，女167例；年龄18～93岁，平均54．8岁。结果肱骨近端骨折多由摔伤所致，其主要的客观原因是安全措施不完善。不同性别及年龄的患者之间受伤特点存在显著差异。在≤60岁年龄段中，男性患者比例明显高于女性患者；〉60岁年龄组，女性患者明显多于男性患者（r=64．860，P=0．0001）。在30～50岁年龄组合并损伤明显高于其他各组（x2=4．637，P=0．0001）。对于〉60岁患者群，肱骨近端骨折中三、四部分骨折的比例明显高于〈60岁的患者群（x2=28．024，P=0．031）。对于合并多种内科疾病的老年患者，其住院天数明显长于内科合并症少的患者。结论肱骨近端骨折多发于中老年患者；摔伤是导致肱骨近端骨折的主要原因。在接受手术治疗的肱骨近端骨折患者中，多为老年患者、尤其以女性患者为主。青壮年肱骨近端骨折合并损伤较多，与交通伤等高能量致伤有关。对于〉60岁的患者群，肱骨近端骨折往往呈现局部损伤严重的特点。

Objective To study clinical characteristics of patients with proximal humeral fracture through a muhicenter research. Methods This retrospective multicenter survey included complete clinical and follow-up data of 307 patients with proximal humeral fracture who received treatment from July 2002 to September 2009 in 5 prominent hospitals affiliated to Peking University, Southern Medical University, Capital Medical University and Sichuan University. They were 140 men and 167 women, aged from 18 to 93 years （average, 54.8 years） . Results The main direct cause of proximal humeral fracture was falling down due to insufficient safety facilities. Injury patterns varied with gender and age group. In age group of younger than 60, there were significantly more males than females; in age group of older than 60, there were significantly more females than males （X2 = 64. 860, P = 0. 0001）. Combined injuries occurred significantly more in age group of 30 to 50 than in other age groups （X2 = 4. 637, P =0. 0001） . Three- or four-part fractures occurred significantly more in patients of more than 60 years old than in patients of younger than 60 years （X2 = 28. 024, P = 0. 031） . Old patients complicated with multiple diseases of internal organs had significantly longer hospital stay than other patients. Conclusions Proximal humeral fractures often occur in old and middle-aged patients, especially in females. Falling is the major cause. Young patients with proximal humeral fracture often have combined injuries due to high-energy traffic accidents. In patients older than 60, the fracture is often very severe.