| Proximal humeral fractures are the fractures which include the fractures of surgical neck of humerus and those above it. Violence plays an important role in inducing the fractures. These fractures have kinds of clinical appearances and close to the articular surface.Most patients suffer from serious osteoporosis. There has been a many of arguments in the treatment constantly.In the wake of the unceasing development of the treatment technic and the continuous renewing of the implant material, the artificial humeral head replacement and the internal fixation with locking compressing plate have been very important treatments for the proximal humeral fractures in the advanced-ages . But, the reports of the therapeutic effects, which cause many disputes, between the two, are not the same domesticly or abroad. With regards to this, we design this research in order to compare advantages, shortages and the therapeutic effect etc.which may provide some information for the choice, in the two treatments.We collect 30 cases of inpatients (above 60 years old) which have been treated and followed-up during 2005.01 to 2008.11. Male: 13 cases; female: 17 cases. Age: 60～80,mean:73. Right: 25 cases; left: 5 cases. NeerⅢ: 24 cases; NeerⅣ: 6 cases. Reason: road accidents 9 cases; falling injury 19 cases; else: 2 cases.LCP:18 cases; AHHR: 12 cases. We take notes of the patients' ages, operation consuming time and the functional recovery. We deal all the data with statistical treatment. Results: The patients in the AHHR group are elder than those in the LCP group(P=0.0408). Operation consuming time in the AHHR group is shoter than those in the LCP group(P=0.0163). The functional recoveries in the two groups do not present statistic differences(P=0.4236).Conclusion: 1. LCP as a new fixator not only reduces the degree of decoherence of soft tissue but also enhance the fixing strength. This kind of therapy provides well curative effects which promise a perfect prospect in being widely used. But it is inevitable to cause many a complication if we overemphasize on micro-injury. So, sufficient preparation before operation, comprehension of the vitodynamics features of LCP and standard operations are essential to the clinical effects. 2. Though in the wake of the unceasing improvement of the material of the artificial joint and the maturity of the technic AHHR shows certain superiority in the treatment for advanced-age'proximal humeral frcatures. There are still risks in the unstability, subsidence and dislocation of the prothesis, even in the causing humeral fractures. And bone cement has toxicity to the vessels. We should master the operation indication strictly. 3. Though LCP and AHHP are both suitable treatments for the advanced-age proximal humeral fractures, we should take comprehensive consideration according to mechanisms of the injury, types of fractures, blood supplies for the humeral head, doctors'abilities and the expected value of the patients.We also should choose the treatments carefully. If every thing is available, we'd prefer AHHP. 4. Functional exercises are to recovery what sculptor is to the marble. We should not ignore the importance of functional exercises nonetherless which kind of treatment we choose. |
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