| BackgroundSmall splint external fixation for fracture treatment is a valuable legacy of traditional Chinese medicine,and it is also the orthopaedic treatment that Shang Tianyu,as the representative of Orthopaedic predecessors,inherited,developed and popularized in the 1970s.Over the past decades,the clinical application of orthopaedics has yielded a certain effect.Due to the structural deficiencies,the treatment of proximal humeral fractures has greatly reduced the effect.For example,manv literatures reported that:①rhombic nodule deformation,splint longitudinal sliding,transverse movement,splint cracking;②axillary nerve and blood vessel compression or pressure sore problems;③ loose fixation needs frequent adjustment,increased workload of doctors,reduced patient compliance,and so on,all affect the curative effect.The new type splint for the treatment of proximal humeral fracture adds new elements on the basis of the traditional splint.After overcoming some shortcomings and defects,it is easier to operate without relying on complex and expensive equipment and materials.It improves the clinical efficacy and creates good social and economic benefitsProximal humeral fracture refers to the fracture above the base of greater tubercle.The incidence of systemic fracture is 5%-9%,which is 3 times higher in women than in men.About 75%of the elderly are over 60 years old.The incidence of osteoporosis is 10%,of which 15%are unstable fractures.Literature reports show that the incidence of proximal humeral fractures in elderly patients will increase threefold in the next 30 years with the aging population and the increase of osteoporosis patientsThe treatment methods of proximal humeral fractures mainly include closed reduction,conservative treatment and open reduction.Non-surgical treatment mainly uses manual reduction and external fixation.The main external fixation includes splint,plaster,traction,shoulder abduction bracket fixation,upper limb suspension cloth towel,etc.There are many surgical treatments for open reduction,including percutaneous pin fixation,trefoil plate,T plate,proximal humerus locking plate(LPHP),proximal humerus anatomical plate PHILOS plate,Multiloc intramedullary nail,semi-shoulder replacement or trans-shoulder joint replacement.At present,there are different opinions on the treatment of proximal humeral fractures and no consensus has been reached.Proximal humeral fractures are common in the elderly.These patients are often accompanied by severe osteoporosis,diabetes or many basic diseases.In addition,some special groups such as pregnant women,models,actors and so on are not suitable for surgical treatment,especially need safe and effective non-surgical treatment,while the traditional Chinese medicine splint fixation therapy is the first choice.Manual reduction combined with external fixation with willow splint is a representative method for conservative treatment of proximal humeral fractures.It overcomes the problems of heavy plaster,unable to adjust at any time,cross-joint fixation and so on.It is a rhombic knot structure wound by cloth strips and connected with four small splints,which span the opposite axillary structure.Four splints,paper cushions and bands produce fixation force,binding force,effect force and internal motive force in fixation and functional exercises to achieve the effect of maintaining fracture reduction and fixation,the curative effect is accurate,and has been recognized by the majority of doctors.But the traditional small splints are connected by "diamond knot".The "diamond knot" is a bandage wound into a ring of flexible rings.When the shoulder joints move in the early stage,the "diamond knot" receives drag deformation.The splints show longitudinal sliding,lateral movement,cracking and loosening between the splints.In order to maintain the fixation,the splints must be bundled with additional force,the operation is tedious,and the splints are frequently adjusted.Light physicians are reluctant to use it and patients refuse to accept it;secondly,traditional splint fixation can not match with the change of circumference caused by extremity swelling subsidence,which can easily lead to invalid fixation and proximal humerus fracture displacement again.In clinical practice,if the splint fixation is too loose or the position of pressure pad is wrong,the fracture end will be displaced again;otherwise,if the bandage is too tight,the fracture end will be displaced again.It will lead to excessive local skin pressure,pressure sores or muscle ischemic necrosis,which can lead to disability in serious cases.In addition,the shape of the board does not conform to the anatomical characteristics of the upper limbs,and it is easy to loose after fixation,which not only affects the clinical efficacy,but also often causes some adverse problems.The key problem to be solved is to prevent the relative movement of the front,back and outside splints and to solve the problem of cracking due to the lack of belt action at the proximal end of the three plates.Based on the application of small splints in the treatment of fracture for nearly 30 years,through further research,we redesigned the key structure of small splints,diamond knot,and added new elements,which overcome the above-mentioned defects,prevented the occurrence of the above-mentioned adverse conditions,improved the stability and reliability of small splints fixation,improved the curative effect,reduced the burden of nursing and increased the number of patients.Compliance of people.ObjectiveThrough the case-control study on the treatment of proximal humerus fracture between the experimental group and the control group,the clinical efficacy of the new splint external fixation and open reduction and PHILOS plate internal fixation for proximal humerus fracture was compared,and its clinical effectiveness and safety were verified,which provided data support for the promotion of the new splint in the future.MethodA prospective non-randomized clinical controlled study was designed by matching and matching methods.The patients with proximal humeral fracture were selected as the subjects.The types of fracture were classified according to Neer classification,and the anatomical classification of proximal humerus was evaluated when the patients were injured.After recording the information of sex,age,left and right sides,injury mechanism,Neer classification of proximal humeral fracture,diagnosis and treatment methods and shoulder function score of patients after treatment,matching requirements(including three important non-experimental factors):the same sex,similar age(difference<5 years),proximal humerus were matched according to the following requirements.Fracture types are identical.After successful matching,the patients treated by manual reduction combined with new splint external fixation were included in the experimental group,and the patients treated by open reduction and philos plate and screw internal fixation were included in the control group.A total of 60 patients(left 26 cases,right 34 cases)were included,including 26 cases of two-part fracture,30 cases of three-part fracture and 4 cases of four-part fracture.At the last follow-up,the pain,muscle strength,range of motion,daily living ability and Neer shoulder function scores of the experimental group were compared between the two groups.ResultAt the last follow-up,the scores of shoulder pain,range of motion,daily living ability and Neer shoulder function were 27.67±2.86、15.27±3.63、31.10±4.19、4.73±0.45、83.77±7.98,respectively in the experimental group,and 25.50±3.31、15.70±4.20、31.73±3.31、4.43±0.50、82.30±8.48,in the control group.According to rank sum test analysis,there was significant difference in shoulder pain score between the experimental group and the control group(P=0.010),and the new small splint group was better than the PHILOS plate group;there was significant difference in shoulder muscle strength score between the two groups(P=0.019),and the new small splint group was better than the PHILOS plate group;there was no significant difference in shoulder joint range of motion score between the two groups.(P=0.766),there was no significant difference between the new splint group and the PHILOS plate group;there was no significant difference in daily living ability score between the two groups(P=0.643);there was no significant difference between the new splint external fixation group and the PHILOS plate internal fixation group;there was no significant difference in shoulder joint function score between the experimental group and the control group(P=0.569);there was no significant difference between the new splint external fixation group and the PHILOS plate internal fixation group(P=0.569).There was no significant difference between HILOS plate fixation group and HILOS plate fixation group.ConclusionIn this study,the effectiveness of manual reduction combined with new splint external fixation in the treatment of proximal humeral fractures was verified by case-matched control study between the experimental group and the control group Compared with the PHILOS plate group,the humeral anatomy score of the patients with new splint external fixation was slightly worse,but at the end of the treatment,the patients also achieved satisfactory shoulder joint function,and The complications such as surgical infection,joint adhesion and invalidation of internal plants were avoided,and the risk of operation was also reduced. |
