甩肩疗法与手术内固定治疗老年肱骨近端骨折的病例对照研究

Comparison of swing shoulder and internal fixation for the treatment of proximal humeral fractures in elderly

目的：比较甩肩疗法与手术内固定治疗肱骨近端骨折的临床疗效.方法：自2007年6月至2012年6月,采用甩肩疗法与手术内固定治疗肱骨近端骨折患者89例,获得随访81例.甩肩疗法组38例,男13例,女25例;年龄62～84岁,平均（67.11±6.18）岁;骨折Neer分型：2部分骨折27例,3部分骨11例.手术内固定组43例,男16例,女27例;年龄60～80岁,平均（66.47±5.48）岁;骨折Neer分型：2部分骨折29例,3部分骨14例.比较两组患者治疗后VAS评分及并发症情况,并采用Constant-Murley功能评分评估患者肩关节功能.结果：81例患者获得随访,时间13～26个月,平均18.3个月.治疗前两组患者VAS评分比较差异无统计学意义.治疗后甩肩组VAS评分（3.11±0.95）与手术内固定组（3.88±1.14）比较差异有统计学意义（t=-3.313,P＜0.05）.甩肩疗法组Constant-Murley功能评分（79.53±3.73）与手术内固定组（77.98±4.11）比较差异无统计学意义（t=1.768,P＞0.05）;甩肩疗法组并发症发生率18.4％（7/38）与手术内固定组39.5％（17/43）比较差异有统计学意义（χ^2=4.313,P＜0.05）.结论：甩肩疗法治疗老年肱骨近端骨折,具有费用低、并发症少、关节功能恢复好的优点;而手术内固定疗效好,但手术并发症风险增加.

Objective：To compare clinical outcomes of swing shoulder and internal fixation in treating proximal humeral fractures.Methods：From June 2007 to June 2012,totally 89 elderly patients with humeral proximal fractures were treated by swing of shoulder or internal fixation,and 81 patients were followed up.In swing shoulder group,there were 38 patients including 13 males and 25 females aged from 62 to 84 with an average of （67.11±6.18） years old; 27 cases were 2-part fractures and 11 cases were 3-part fractures according to Neer classfication.In internal fixation group,there were 43 patients including 16 males and 27 females aged from 60 to 80 with an average of （66.47 ±5.48） years old;and 29 cases were 2-part fractures and 14 cases were 3-part fractures according to Neer classfication.VAS score and complications were compared between two groups after treatment,and Constant-Murley functional scoring was used to evaluate shoulder function of patients.Results：Eighty-one patients were followed up from 13 to 26 months with an average of 18.3 months.There was no significant difference in preoperative VAS score between two groups.After treatment,VAS score in swing shoulder group was （3.11± 0.95）,and （3.88±1.14） in internal fixation group,and had significant difference between two groups （t=-3.313,P〈0.05）.There was no significant difference in Constant-Murley scores between swing shoulder group （79.53±3.73） and internal fixation group （77.98±4.11） （t=1.768,P〉0.05）.Postoperative complications in swing shoulder group was 18.4% （7/38）,39.5% （17/ 43） in internal fixation group,and had significant differences between two groups （χ^2=4.313,P〈0.05）.Conclusion：Swing shoulder for the treatment of proximal humeral fractures in elderly has advantages of low cost,less complications and good recovery of joint function;while internal fixation has a good therapeutic effect but increased complications.