老年肱骨近端3-4部分骨折手术与保守治疗的疗效和费用分析

Comparison of clinical result and total costs between surgical and non-operative treatment for 3 and 4 part proximal humeral fracture in the elderly

目的比较老年肱骨近端骨折手术与保守治疗的临床疗效和总体费用,总结临床经验。方法收集2019年1月至2020年3月于北京积水潭医院就诊的72例老年肱骨近端3-4部分骨折患者的临床资料,根据治疗方式不同将患者分为手术组和保守组,其中手术组患者39例,住院后接受切开复位内固定术;保守组患者33例,给予患肢制动、肢具固定等非手术处理。治疗结束后通过电话和门诊复查的方式对患者进行定期随访。采用Constant-murley评分和DASH调查表评估患者肩关节和上肢整体功能,采用欧洲五维健康量表(EQ-5D)评估患者生活质量,根据北京积水潭医院医疗记录和标准费用法统计患者伤后总体费用。数据比较采用t检验、秩和检验以及卡方检验。结果所有患者均完成2年随访。随访期间手术组和保守组患者并发症发生率分别为28.2%和21.2%,差异无统计学意义(χ^(2)=0.466,P=0.495)。术后1年手术组和保守组患者肩关节功能分别为(76.1±10.5)分和(68.6±11.7)分,差异有统计学意义(t=8.772,P<0.05),上肢整体功能分别为(26.7±20.5)分和(32.1±11.7)分,差异有统计学意义(t=8.331,P<0.05),生活质量分别为(0.78±0.21)分和(0.72±0.21)分,差异有统计学意义(t=9.033,P<0.05),手术组均明显优于保守组。术后2年手术组和保守组患者肩关节功能分别为(78.3±10.3)分和(69.6±8.5)分,差异有统计学意义(t=9.031,P<0.05),上肢整体功能分别为(24.2±19.3)和(31.1±11.5)分,差异有统计学意义(t=9.309,P<0.05),生活质量分别为(0.79±0.19)分和(0.76±0.16)分,差异无统计学意义(t=1.201,P=0.102)。末次随访时手术组和保守组患者总体费用分别为52171.2元和11108.5元,手术组明显高于保守组,差异有统计学意义(Z=8.201,P<0.05)。结论老年肱骨近端3-4部分骨折手术和保守治疗均可取得良好的临床疗效。与保守治疗相比切开复位内固定术更有利于患者早期关节功能恢复和生活质量的提高,但患者的总体花费也较高。

Objective To compare the clinical effect and costs of open reduction with internal fixation(ORIF)and conservative treatment for 3 and 4 part proximal humeral fractures.Methods The data of 72 elderly patients with 3 and 4 part proximal humeral fractures were collected in this study from January 2019 to March 2020.According to the treatment plan the patients were divided into operative group(39 cases)and non-operative group(33 cases)respectively.The Constant-murley scores and DASH(disabilities of the arm,should and hand)questionnaire were applied to evaluate the function of shoulder joint and upper limbs.The EuroQol 5 dimensions scores(EQ-5D)were applied to evaluate the quality of life after injury.The total costs of each group were collected by medical record and standard methods.Results All the patients completed more than 2 years follow-up.Compared to non-operative group the incidence rate of complication was higher in operation group,the difference was not statistically significant(28.2%vs.21.2%,χ^(2)=0.466,P=0.495).In 1 year follow-up the Constant-murley scale in operative and non-operative group was(76.1±10.5)pointsand(68.6±11.7)points,the difference was statistically significant(t=8.772,P<0.05),Dash sacel was(26.7±20.5)points and(32.1±11.7)points,repectively,the difference was statistically significant(t=8.331,P<0.05),and EQ-5D scale was(0.78±0.21)points and(0.72±0.21)points,the difference was statistically significant(t=9.033,P<0.05).All the outcome favored ORIF.After 2 years Constant-murley scale in operative and non-operative group was(78.3±10.3)points and(69.6±8.5)points,the difference was statistically significant(t=8.772,P<0.05),Dash sacel was(24.2±19.3)points and(31.1±11.5)points,repectively,the difference was statistically significant(t=8.331,P<0.05),and EQ-5D scale was(0.79±0.19)points and(0.76±0.16)points,repectively,the difference was statistically significant(t=9.033,P<0.05).At the last follow-up the total costs for operative and non-operative group were 52171.2 yuan and 11108.5 yuan,the difference was statistically significant(Z=8.201,P<0.05).Conclusion Both operation and conservative treatment can provide satisfactory clinical effect for elderly patients with 3 and 4 part proximal humeral fracture.However compared to conservative treatment ORIF is a more desirable treatment for early function recovery and quality of life with higher total costs.