老年肱骨近端骨折治疗效果影响因素的分析研究

Analysis of the influencing factors in the treatment of proximal humerus fractures in elderly patients

目的探讨研究影响老年肱骨近端骨折治疗效果的相关因素。方法对2000年7月～2010年7月在我科住院治疗的32例老年肱骨近端骨折患者进行回顾性分析,所有随访患者接受详细肩关节体检、肩关节X线片检查。应用Constant-Murley评分和牛津肩关节功能问卷,评估患者肩关节功能恢复情况。统计分析致伤因素、骨折合并症、骨折分型、手术方式、功能锻炼等各项指标与骨折治疗效果之间的关系,以了解影响治疗效果的各种因素。结果交通伤致肱骨上段骨折的预后差于摔伤;患者伴发损伤或合并内科疾病的预后差于没有的患者;骨折分型越高,治疗效果越差;对于NeerⅣ型骨折,进行钢板内固定与肱骨头置换的治疗效果无显著差异。结论结合患者的致伤因素、骨折合并症、骨折分型以及合并的内科疾病,方可制定针对性的治疗方案。科学的术后功能锻炼,是使患者获得最佳功能恢复的关键。

Objective To investigate the influential factors in the treatment of proximal humerus fractures in elderly patients. Methods Clinical data of 32 elderly patients with proximal humerus fractures, who received treatment in our department from July 2000 to July 2010, were retrospectively analyzed. All the patients received physical and X-ray examination. Constant-Murley score and Oxford shoulder joint function questionnaire were used to evaluate the recovery of shoulder joint function. The correlation among injury cause, complications, classification, operation methods, functional training was analyzed, in order to understand the various factors affecting the therapeutic effect. Results The prognosis of traffic injury was worse than that of fall damage. The prognosis of patients with associated injury or internal medical diseases was worse than that of those without. The higher the Neer classification, the poorer the prognosis was. There was no significant difference between plate internal fixation and the humerus head replacement for the treatment of type IV Neer fracture. Conclusion Treatment strategy should be made according to the cause of injury, fracture complication, fracture classification, and combined internal medical diseases. Scientific postoperative function exercise plays the key role in the process of best functional recovery.