锁定钢板内固定与非手术治疗老年肱骨近端NEER 3、4型骨折的效果

Effect of Locking Plate Internal Fixation and Non-Surgical Treatment of Proximal Humeral Fractures in the Elderly with NEER Classification 3 and 4 Part

目的:探讨切开复位锁定钢板内固定术治疗与非手术治疗NEER分型3、4型老年肱骨近端骨折的临床疗效。方法:选择2015年1月-2018年1月北京市顺义区医院收治NEER分型3、4型老年肱骨近端骨折患者136例,按不同治疗方法分为两组。对照组给予牵引复位后悬吊贴胸固定治疗;观察组行切开复位锁定钢板内固定术治疗。比较两组骨折愈合情况、肩关节功能及总体健康状况、并发症发生情况。结果:两组愈合时间比较,差异无统计学意义(P>0.05)。随访12个月时,两组Constant-Murley评分及EQ-5D评分比较,差异均无统计学意义(P>0.05)。观察组并发症发生率高于对照组,差异有统计学意义(P<0.05)。结论:切开复位锁定钢板内固定与非手术治疗NEER分型3、4型老年肱骨近端骨折在骨折愈合时间、术后1年肩关节功能及总体健康状况方面效果相当,但手术治疗并发症风险高于非手术治疗。

Objective:To investigate the clinical effects of open reduction and locking plate internal fixation versus non-surgical treatment of elderly patients with NEER 3-and 4-part proximal humeral fractures.Methods:From January 2015 to January 2018,136 elderly patients with NEER 3-and 4-part proximal humeral fractures were selected from Beijing Shunyi Hospital,and they were divided into two groups according to different treatment methods.The control group was treated with suspension and thoracic fixation after traction reduction.The observation group was treated with open reduction and locking plate internal fixation.The fracture healing,shoulder joint function,general health,and complications were compared between the two groups.Results:There was no significant difference in the healing time between the two groups(P>0.05).There was no significant difference in ConstantMurley score and EQ-5D score between the two groups at 12 months of follow-up(P>0.05).The incidence of complications in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Open reduction and locking plate internal fixation and non-surgical treatment of elderly patients with NEER 3-and 4-part proximal humeral fractures are equivalent in terms of fracture healing time,shoulder joint function at 1 year after surgery and general health,however,the risk of complications of surgical treatment is higher than that of non-surgical treatment.