The Comparative Study Of The Treatment Of Proximal Humeral Fracture Between Closed Reduction With Percutaneous Pinning And Open Reduction With Anatomic Plate

Objective:To compare the efficacy of the treatment of proximal humeral fracture between closed reduction with percutaneous pinning and open reduction with anatomic plate, analyze application features in different fracture classifications,explore the indications and clinical value applying to different fracture classifications,and to find out the suitable method for treating proximal humeral fracture.Methods:Depending on retrospective analysis,we reviewed all cases operated on NeerⅡ,Ⅲfrom January 2005 to November 2007 in our hospital.All cases accordancing with our selection standards and followed up were divided into two groups.One was closed reduction with percutaneous pinning,the other was open reduction with anatomic plate.We used the Constant-Murley Scores to make out the excellence rate of clinical outcome and to compare the different excellence rate of the two groups.Moreover,through statistical comparison of operating time,blood loss and the postoperative motion scores of the shoulder,we evaluated the clinical efficacy and their relative factors.Results:Two groups were all followed.There were 21 cases in the closed reduction with percutaneous pinning group were evaluated.According to the Constant Scoring excellent in 9 cases,good in 10 cases,moderate in 1 cases poor in 1 case and the excellent rate was 90.5%. While there were 21 cases in open reduction with anatomic plate were studied.And also according to the Constant Scoring excellent in 8 cases,good in 7 cases,moderate in 4 cases, poor in 2 cases and the excellent rate was 71.4%.Meanwhile,the operating time in the percutaneous pinning group was less than that of anatomic plate group.There was less invasive,less blood loss,less blood tansfusion in the percutaneous pinning group than that of in the anatomic plate group,so there was obvious significant difference between two groups(P＜0.05).The time of fluoroscopy in operation the percutaneous pinning group was more than the anatomic plate group.The recovering motion scores of the shoulder in the percutaneous pinning group were much better than in the anatomic plate group. Constant-Murley scores after operation:the percutaneous group was 81.00±8.35,and the anatomic plate group was 88.52±6.48,so there was obvious significant difference between two groups(P＜0.05);The degree of anterior flexion and superduct of the shoulder at 12 weeks and 24 weeks:the percutaneous group were 101.1±9.2°,133.1±15.4°,and the anatomic plate group were 80.8±14.0°,118.0±15.5°,there was obvious significant difference between two groups(P＜0.05);The complications in the near future:there was 1 case ached in the percutaneous group after operation,there was no patient with stiffness of joint,infection and periarthritis of shoulder;and there were 2 cases ached and 5 cases with stiffness of joint,so there were 7 cases worse of the joint function of shoulder in all.There was obvious significant difference between two groups by x~2 test(P＜0.05).Conclusion:The clinical efficacy of the treatment for proximal humeral fractures of NeerⅡ,Ⅲby using percutaneous pinnings was better than that by using anatomic plates. There were less blood loss in the operation,the recovering motion in the postoperation,the less complications because of the less invasive in the percutaneous pinnings group.As a result it is a favorable method for the treatment in clinical.