The Analysis Of Clinical Curative Effect Of Proximal Humerus Fractures Treated By Conservative Management And Surgical Treatment

Obective:To sum-up recently study and development of therapy in the fracture of proximal humerus, and to compare the conservative management (manipulated reduction with external splint fixation) with the surgical treatment (opened reduction with inner fixation).Then analyze the factors which have effects on cure and give scientific support to the therapy of healing the fracture of proximal humerus.Method:A retrospective study was performed on 60 cases who had treatment with fracture of proximal humerus from 2003 to 2006 (30 cases in the group of conservative management, 30 cases in the group of surgical treatment). After one-year follow-up,we grade the patients according to the Constant and Murley' s system which evaluates the clinical effect by judging the pain and the movement of the shoulder joint, the recoveryof thepower of muscles.Then we analyze and compare the therapeutic effect by Rigit test, analyze the factors which have effects on cure with the information of radiography which was taken before the treatment.Result:Grade the patients according to the Constant and Murley' s system. The excellent rate in the group of conservative management(the first group) is 90%, which the excellent rate in the group of surgical treatment(the second group) is 86.7%. The difference of the scores were not significant (P＞0.05). But the normal life and work,the pain in the first group is better than thesecond group.The reduction of the fracture and the strength test in the second group is better than the first group. We found that in long-term follow-up the therapeutic effect, the recovery function of shoulder in the first group is better. The patients of the first group had less complication. And the patients can basically have the normal life and work. Few of them had been influenced in the normal life.Conclusion:①The pain of the shoulder joint, the normal life and work in the first group is better than the second group. And in long-term follow-up the therapeutic effect, the recovery function of shoulder in the first group is better. The patients of this group had less complication.②As the factures without displacement, 2 parts factures and partial of three parts factures, the conservative management should be choose primarily;while the seriously 3～4 parts factures with displacement were much tougher, the surgical treatment should be choose primarily. Conservative management, limited surgery ,open reduction and fixation, total shoulder replacement and so on can be chosen. As the fracture of proximal humerus, we should consider the conservative management first, and if the surgery inevitable we should choose the right surgery which is base on the fracture' s degree and basic physical condition of the patients.