Therapeutic Effect Analysis Of Artificial Humeral Head Arthroplasty For The Therapy Of Proximal Humeral Neer Three And Four-part Fractures In Elderly Patients

Objective:To investigate the efficacy of using artificial humeral head arthroplasty for the therapy of Neer three and four-part proximal humeral fractures in elderly patients.Methods:A total of 88 patients(age>65 years)with Neer three and four-part proximal humeral fractures who were treated in the department of joint surgery of Affiliated Hospital of Yanbian University were retrospectively analyzed from September 2014 to May 2016.According to the Neer classification,34 cases of which are three-part proximal humerus fractures,54 cases of which are four-part proximal humerus fractures.According to the therapy method,it was divided into:45 cases with artificial humeral head arthroplasty group(replacement group)and 43 cases with locking compression plate fixation group(internal fixation group).The operative time,intra-operative blood loss,postoperative complications,Neer shoulder function score,Constant-Murley shoulder function score at 3,6 and 12 months,Neer shoulder function score excellency rate and Constant-Murley shoulder function score excellency rate at 12 months were compared between the two groups.Results:All patients were followed up for 12 to 30 months,averaging 18 months.There were significant differences in the operative time,intra-operative blood loss and postoperative complications between the replacement group and the internal fixation group(P<0.05).According to the Neer shoulder function score criteria:functional scores at 3,6 and 12 months postoperatively,the replacement group(48.51±3.26,76.36±2.60,85.76±5.19)was higher than that in the internal fixation group(39.21±3.99,65.56±2.31,75.16±6.23),the difference was statistically significant(P<0.05);postoperatively at 12 months function,range of motion,anatomical reduction and excellent rate,the replacement group(26.43±1.95,22.87±2.08,8.80±0.79,93.33%)were higher than those in the internal fixation group(24.42±2.07,17.81 ±1.79,6.53±1.14,69.77%),the difference was statistically significant(P<0.05).According to the Constant-Murley shoulder function score criteria:functional scores at 3,6 and 12 months postoperatively,the replacement group(49.33±7.86,77.47±2.65,91.16±3.75)was higher than that in the internal fixation group(40.44±3.94,66.81±2.36,78.53±6.36),the difference was statistically significant(P<0.05);after 12 months the daily life,range of motion,muscle strength and excellent rate of surgery,the replacement group(17.20±1.44,36.22±1.92,24.89±0.75,95.56%)was higher than that in the internal fixation group(11.86±1.97,31.53±2.13,22.79±2.51,72.09%),the difference was statistically significant(P<0.05).Conclusion:Artificial humeral head arthroplasty in elderly patients,the therapy of proximal humerus Neer three and four-part fractures has good surgical effect.