A Comparative Study Of Elderly Comminuted Proximal Humeral Fractures Treated By Humeral Head Replacement And Locking Proximal Humerus Plate Fixation

Objective A comparative analysis of the therapeutic effect humeral head replacement and Locking proximal humerus plate fixation in the treatment of elderly comminuted proximal humerus fractures for exploring its ideal surgical method.Methods From August 2011 to June 2014,we treated 54 patients with elderly comminuted proximal humeral fractures in the Third Affiliated Hospital of Anhui Medical University, including 29 males and 25 females, the average age of the former(64.4 ± 16.2) years, surgery patients had no history of shoulder stiffness or decreased muscle strength. According to Neer classification standard, three-part fractures in 20 cases, four-part fractures in 34 cases, no significant damage nerves and blood vessels, combined with shoulder joint dislocation, 3 cases of emergency manual reduction. humeral head replacement in 29 patients(replacement group) and proximal humeral locking plate(LPHP) fixation(internal fixation group) 25 cases in 54 patients,The operation time was 5-9 days after injury, mainly in surgery about a week. General information groups were comparable. Were compared operative time, blood loss, complications occurred after 1 year Constant-Murl Hy shoulder score and follow-up. All the data were counted by using SPSS16.0 statistical software,, P <0.05 was considered statistically significant.Results Replacement and internal fixation group operative time was(72.63 ± 9.85),(94.26 ± 10.35) min, blood loss was(170.36 ± 48.27),(260.73 ± 56.37) m L, 1 year after Constant-Murl Hy shoulder joint total score was(78.37 ± 8.35),(71.01 ± 9.27) points, the difference between the two groups were statistically significant(P <0.05). Two sets of 14 to 19 months of follow-up, the replacement group had 2 cases of joint instability, internal fixation group had shoulder stiffness in 2 cases, 2 cases of aseptic necrosis of the humeral head, two complications rates was statistically significant(P <0.05).Conclusions Humeral head replacement surgery for the treatment of patients in this study has a shorter operative time, less blood loss, and better shoulder function recovery of operation, and recent fewer complications, the treatment effect of after operation is better than LPHP fixation,it should be worth clinical application.