| Objective:To compare the clinical efficacy of traditional incisional internal fixation(deltoid pectoralis major approach)and Chinese orthopedic manipulation combined with minimally invasive surgery(small anterolateral incision through the deltoid muscle)in the treatment of proximal humerus fractures by setting up a control group and an experimental group,to provide a less invasive,safe and efficient treatment for proximal humerus fractures and to give more This study was conducted to provide a less invasive,safe and efficient treatment for proximal humerus fractures and to provide more clinical workers with treatment ideas.Methods:In this study,patients with proximal humerus fractures admitted to the Department of Orthopedics of Shandong Provincial Hospital of Traditional Chinese Medicine(Shandong Orthopedic Hospital)from 2019-09 to 2022-06 were included in the group.After admission,routine examinations such as X-ray,CT and ECG were improved;relevant consultations were improved to further clarify the diagnosis,and after the indications for surgery were available,the patients were randomly divided into two groups:the control group and the experimental group,with the premise of obtaining the patients’informed consent.Before surgery,both groups were treated with conventional blood circulation and blood stasis activation,swelling and pain relief,and the affected limb was suspended in a forearm sling,and the surgical treatment was actively prepared to be performed as soon as possible after the operation.The control group was treated with traditional incisional internal fixation(deltoid pectoralis major approach),while the experimental group was treated with Chinese orthopedic manipulation combined with minimally invasive internal fixation(through a small anterolateral incision of the deltoid muscle).The basic information of the patients was recorded,including age,gender,and Neer’s staging;the intraoperative and postoperative related indexes of the control and experimental groups were recorded,including the amount of intraoperative bleeding,incision length,and the number of postoperative hospital days;the VAS scores of the control and experimental groups on the 1st,4th,and 7th postoperative days were recorded(the higher the score,the stronger the pain);the Constant-Murley shoulder function scores at postoperative months 1,3,and 6(higher scores represent better functional recovery of the patient);postoperative complications(e.g.,internal fixation failure,poor incision healing,humeral head necrosis,etc.)at follow-up were recorded.The results of the experimental data were used to further analyze the differences and causes arising from the two,and to provide reference information for clinical purposes.SPSS 25.0 was used for statistical analysis,and the X2 test was used for comparison of the count data.The normal test was performed on the measurement data,and the independent sample t-test was used if the results conformed to the normal distribution;the rank sum test was used if the results conformed to the skewed distribution,and p≦0.05indicated a statistical difference,and p<0.01 indicated a significant difference.Results:The basic data in this study were as follows:control group:12 males,18females;age 58.83±15.10 years;fractures according to Neer’s classification:13 cases of type II,14 cases of type III,and 3 cases of type IV.Test group:7 males,23 females;age62.73±15.56 years;fractures according to Neer’s classification:14 cases of type II,13cases of type III,and 3 cases of type IV.The differences in gender(χ~2=1.926,P=0.165),age(t=-0.985,P=0.292),and fracture type(Z=-0.221,P=0.825)between the two groups were not statistically significant(P>0.05)and were comparable.Postoperative complications:There was a statistical difference between the two groups in terms of postoperative complications(χ~2=4.320,P=0.038),and the incidence of postoperative complications in the experimental group was lower than that in the control group.Intraoperative bleeding:The intraoperative bleeding volume was(165.83±16.56)ml in the control group and(70.33±12.17)ml in the test group,and there was a significant difference in the intraoperative bleeding volume between the control and test groups(difference 95.50,95%CI 87.97-103.26,t=25.450,P<0.01).Incision length:The median incision length was12(10.0,15.0)cm in the control group and 5.0(4.0,6.0)cm in the trial group,with a significant difference between the two groups(Z=-6.727,P<0.01).Postoperative hospital stay:The median number of postoperative hospital days was 5.5(4.0,7.0)days in the control group and 4.0(3.0,6.0)days in the experimental group,with a statistical difference between the two groups(Z=-2.020,P<0.05),indicating that the use of TCM manipulation combined with minimally invasive surgery can reduce the hospital stay and improve the bed VAS scores:on the first postoperative day in the control group(6.00±1.55)and in the test group(5.17±1.18),there was a statistical difference between the control group and the test group in the VAS scores on the first postoperative day(difference 0.83,95%CI0.12-1.55,t=2.340,P<0.05);on the fourth postoperative day in the control group(4.23±1.33)score,test group(4.13±1.25),no statistical difference between control and test groups on VAS scores on the fourth postoperative day(difference 0.10,95%CI-0.57--0.77,t=0.300,P>0.05);on the seventh postoperative day control group(2.37±1.40),test group(2.33±1.42),control and test groups on There was no statistical difference in VAS scores between the control group and the test group on the seventh postoperative day(difference0.03,95%CI-0.70--0.76,t=0.091,P>0.05);this indicates that Chinese orthopedic manipulation with minimally invasive surgery in the early postoperative period can significantly relieve patients’pain and facilitate their early recovery.Constant-Murley shoulder function scores:1st month postoperative There was a significant difference in the Constant-Murley shoulder function score between the control group and the test group at the first month after surgery(difference-12.93,95%CI-15.14--10.72,t=-11.712,P<0.01);at the third month after surgery,the control group(61.50±5.18)and the test group(61.50±5.18)showed a significant difference in the Constant-Murley shoulder function score.(61.50±5.18)and test group(68.93±4.61),with a significant difference between the control and test groups at 3 months postoperatively(difference-7.43,95%CI-9.97--4.90,t=-5.874,P<0.01);at 6 months postoperatively,control group(87.50±3.59)and test group(88.47±3.80),with a significant difference between the control group and test group at 3months postoperatively.(3.80)scores,there was no statistical difference between the control group and the test group in the scores at 6 months postoperatively(difference-0.96,95%CI-2.88-0.94,t=-1.013,P>0.05),and from the long-term follow-up,there was no significant difference in the shoulder scores between the two groups.Conclusion:Through the analysis of the results of the control and experimental groups,for proximal humerus fractures,Chinese medicine manipulative repositioning combined with minimally invasive surgical treatment can reduce surgical trauma,shorten the length of incision,reduce intraoperative bleeding,shorten postoperative hospitalization time,and can effectively reduce postoperative pain,support early functional exercise of patients,and have good safety and stability with rapid postoperative recovery of shoulder joint function.Therefore,the use of TCM orthopedic manipulation combined with minimally invasive surgery for proximal humerus fractures is a proven treatment method. |
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