| The research background:Proximal humeral fractures are common fracture type,with the aging of our population more and more serious,more cases of elderly patients with fractures.Treatment of proximal humeral fractures are diverse,there is no unified standard treatment so far.There are more controversies about the treatment of fractures of the proximal humerus,especially the NEER type ? fracture.Some people tend to press the locking plate treatment,they believe that anatomical reduction plus strong internal fixation is a better treatment,you can sacrifice part of the blood;Some scholars have stressed that minimally invasive,no need to fully emphasize the anatomical reduction,functional reset can restore the basic functions of patients on the line.Pressure locking plate,locking intramedullary pin system become a more representative two internal fixation material.More and more medical personnel try minimally invasive surgery method to solve the clinical problems,especially the bone fracture.Objective:As the continues surge of China's elderly population,the demand of elderly medical is also increasing.Fractures of the proximal humerus is a common occurrence in the elderly population,by retrospective analysis of the proximal Neer type two part fracture patients in our hospital senile humerus,we study the disadvantage and the advantage of Interlocking intramedullary nail with locking compression plate by Neer type two part fracture curative effect.In order to verification of more suitable for elderly patients with proximal humeral fractures,to provide medical care for the ageing society.Materials and methods:This retrospective study began in the hospital of China Japan Union Hospital of Jilin University from March 2014 to July 2016.We chose 89 elderly patients in the Department of orthopedics with proximal humeral fractures.then from the selection of standard proximal humerus Neer type two part fractures in 38 patients,they were all fresh fractures,at the age of 55 to 75 years,average at 63 years old.Including 20 males and 18 females,20 farmers and 18 retirees.The treatment of patients in 15 cases of interlocking intramedullary nail is defined A group,including 8 males,7 females,car accident injured 5 people,their own fall 10 people,1 with the same side of the clavicle fracture,1 person with lower limb fractures,10 farmers,5 retired workers.We defined the locking compression plate in the treatment of patients as B group,including 12 males,11 females,15 people injured by car,8 people were hurt themselves by falling,3 people with lower limb fracture,16 employees,retirees 7 people.The corresponding indexes of two groups were observed and compared,and the fractures were classified by Neer classification of the four parts of the fracture.The evaluation criteria of shoulder joint function were evaluated by NEER shoulder function score([1]).Statistical method:SPSS 17.00 software was used to analyze the test and X2 test respectively,and the difference was statistically significant with p<0.05.Result:In group A,the amount of intraoperative blood loss,operative time,incision length and postoperative drainage volume in the treatment group were less than those in the B group(P<0.01).Postoperative follow-up of 10 to 16 months,the average is 14.6 months.During this time we find A group: intramedullary nail group had 1 cases of complications in patients with nonunion but results of shoulder joint assessment is better than that of B group plate group,B group of steel plate group nonunion,fracture fixation failure and humeral head necrosis of the cases.The fracture healing time no obvious difference(difference p>0.05 statistics).Conclusion:The treatment of the proximal humerus neer type ? fracture in the elderly is subject to a variety of factors,the effect of interlocking intramedullary nail fixation on blood supply to fractures was relatively small and had little effect on overall body activity.After appropriate functional exercise,the surgery is better,can achieve the doctor and patient satisfaction results. |
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