手法复位小夹板外固定治疗老年Neer Ⅲ型肱骨近端骨折36例

36 Cases of Manual Reduction with Small-splint External Fixation Treating for Proximal Humerus Fractures of Neer Ⅲ Type in Elderly

目的:探讨手法复位小夹板外固定治疗老年NeerⅢ型肱骨近端骨折的临床疗效。方法:将符合纳入标准的78例老年NeerⅢ型肱骨近端骨折患者按治疗方式分为保守组(36例)和手术组(42例),保守组采用手法复位小夹板外固定治疗,手术组采用切开复位锁定钢板内固定治疗,分别观察和比较两组患者影像学骨折复位情况、并发症、肩关节功能以及临床疗效。结果:保守组患者影像学骨折复位优良率为52.78%,而手术组优良率为90.48%,差异有统计学意义(P=0.000 1);保守组并发症总发生率(11.11%)明显低于手术组(30.95%),差异有统计学意义(μ=3.952 0,P=0.000 1);在术后第6周及第3个月随访,手术组患者Constant-Murley肩关节功能评分结果均优于保守组,差异有统计学意义(P<0.05);随着随访时间延长,两组患者Constant-Murley肩关节功能评分差异逐渐变小,在术后第6个月、1年时,差异无统计学意义(P>0.05);保守组临床疗效优良率为75.00%,手术组优良率为83.33%,差异无统计学意义(μ=1.005 2,P=0.314 8)。结论:两种治疗方式治疗老年NeerⅢ型肱骨近端骨折均可获得满意的临床疗效和肩关节功能恢复,但切开复位锁定钢板内固定治疗可获得更好的骨折复位,而手法复位小夹板外固定治疗并发症更少。

Objective： To investigate the clinical efficacy of manual reduction with small-splint external fixation treating for the proximal humerus fracture of Neer Ⅲ type in elderly. Methods： All 78 elderly patients with proximal humerus fracture of Neer Ⅲ type, who met the inclusion criteria, were divided into the conservative group（n=36）and the operation group（n=42）according to the standard of treatment. The conservative group was treated by external fixation with small-splint external fixation, and the surgical treatment group was treated by open reduction with anatomic plate internal fixation. The image fracture reduction, the complications, the shoulder function and the clinical efficacy were observed and compared between the two groups. Results： The excellent and good rate of radiographic fracture reduction was 52.78% in the conservative group and 90.48% in the operation group. There was significant difference between the two group（P=0.000 1）. The overall complication rate in the conservative group（11.11%）was significantly lower than that in the surgery group（30.95%）（μ=3.952 0, P=0.000 1）. The Constant-Murley shoulder function score in surgery group was better than that of conservative group at the follow-up time points of 6 weeks and 3 months after surgery（P〈0.05）. With the extension of follow-up time, the difference of the Constant-Murley shoulder function score between the two groups gradually became smaller, and there was no significant difference at 6 months and 1 year after operation（P〉0.05）. The excellent rate of the curative effect was 75.00% in the conservative group and 83.33% in the operative group. There was no significant difference between the two groups（μ=1.005 2,P=0.314 8）. Conclusion： The two kinds of treatment for the proximal humerus fracture of Neer Ⅲ type in elderly can get satisfactory clinical efficacy and shoulder function recovery. The open reduction with anatomic plate internal fixation can get a better fracture reduction, but the external fixation with small-splint can get fewer complications.