手术与非手术治疗老年肱骨近端复杂骨折疗效比较

EFFECTIVENESS COMPARISON OF OPERATIVE AND NON-OPERATIVE TREATMENT FOR COMPLEX PROXIMAL HUMERAL FRACTURES IN ELDERLY PATIENTS

目的比较手术与非手术治疗老年肱骨近端三、四部分骨折的疗效。方法 2009年1月-2011年1月,收治35例肱骨近端三、四部分骨折老年患者。其中20例行切开复位、锁定钢板内固定治疗(手术组),15例行闭合复位、夹板或石膏外固定(非手术组)。两组患者性别、年龄、病因、骨折分型及病程等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。两组治疗后均行正规功能锻炼。结果手术组患者术后切口均Ⅰ期愈合。两组患者均获随访,随访时间12～20个月,平均16个月。X线片检查示,除手术组1例(5.0%)骨折不愈合,其余患者骨折均愈合。手术组2例(10.0%)、非手术组1例(6.7%)发生内翻畸形,手术组1例(5.0%)、非手术组1例(6.7%)发生肱骨头缺血性坏死。两组以上并发症发生率比较,差异均无统计学意义(P>0.05)。末次随访时,手术组与非手术组肩关节功能Constant-Murley评分分别为(66.8±11.8)分及(64.7±9.9)分,比较差异无统计学意义(t=0.59,P=0.47)。结论手术与非手术治疗老年肱骨近端三、四部分骨折疗效相似,对手术风险高、日常活动要求低或拒绝手术治疗的老年患者可选择非手术治疗。

Objective To compare the effectiveness between operative and non-operative treatment for 3-and 4-partproximal humeral fractures in elderly patients.Methods Between January 2009 and January 2011,35 patients with 3-or4-part proximal humeral fractures were treated with open reduction and locking plate internal fixation（n=20,operative group）and with closed reduction and splint or cast fixation（n=15,non-operative group）.There was no significant diff erence in gender,age,etiology,fracture type,and disease duration between 2 groups（P〉0.05）.The postoperative rehabilitation protocol wasperformed in 2 groups.Results All patients of the operative group achieved healing of incision by first intention.All patientswere followed up 16 months on average（range,12-20 months）.The X-ray films showed that the other fractures healed except1 case（5.0%） nonunion in operative group.Varus malunion was found in 1 case（6.7%） of non-operative group and 2 cases（10.0%） of operative group.Humeral head necrosis was found in 1 case respectively in 2 groups（5.0% and 6.7%）.There wasno significant diff erence in complication incidence between 2 groups（P〉0.05）.The Constant-Murley scores of non-operativegroup and operative group were 64.7 ± 9.9 and 66.8 ± 11.8 at last follow-up respectively,showing no significant diff erence（t=0.59,P=0.47）.Conclusion Operative treatment has similar effectiveness to non-operative treatment for 3-and 4-part proximalhumeral fractures.In elderly patients,non-operative treatment should be chosen.