| Objective:A fracture of the proximal humerus is a fracture of the anatomical neck,surgical neck,tubercle of size,and humeral head of the upper humerus.Is a common fracture in the elderly,in the elderly population,this type of fracture has a high share,Most of the causes of proximal humeral fractures in the elderly are direct and indirect violent injuries.Severe bone fragility,thin bone cortex and osteoporosis in the elderly due to bone loss,In daily life,low-energy injuries such as minor collisions and falls can easily lead to proximal humeral fractures,In the anatomy of the shoulder,the anterior and posterior circumflex brachial artery from the axillary artery continues to supply blood to the humeral head.At the time of the fracture,due to the conduction of energy,The muscle system of the shoulder joint pulls on the bone and causes the fracture mass at the fracture to shift into an angle.There's a good chance of damage to the nutrient vessels of the humeral head.Increased the risk of humeral head necrosis,It causes a lot of trouble to the quality of life of the patients.At present,plate internal fixation and artificial shoulder joint replacement are often used in the treatment of comminuted fractures of proximal humerus in the elderly.Therefore,this paper makes an analysis and summary of the curative effect of the two surgical methods.Method:From January 2016 to January 2019,40 elderly patients(? 65 years old)with proximal humeral fractures treated in the Department of Orthopaedics,the first affiliated Hospital of Kunming Medical University,were studied retrospectively.The type of fracture in all elderly patients is comminuted fracture of proximal humerus(Neer classification is three-part and four-part fracture).The patients were randomly divided into two groups,20 patients in the fixation group,including 8 males and 12 females,with an average age of 73.1±6.1 years,were treated with open reduction and plate internal fixation.20 patients in the replacement group,including 6 males and 14 females,with an average age of 75.0±5.8,were treated with hemishoulder arthroplasty.The recovery effect of shoulder joint function,surgical indexes,postoperative hospitalization,Neer score,Constant-Murley shoulder joint function score,VAS pain score and patient satisfaction were compared between the two groups.Result:All 40 patients had a smooth operation,no death,no complications such as vascular and nerve injury,All patients in this study were followed up for 8 to 25 months.The drainage volume in the replacement group[(49.5±10.2)ml]and 48 hours after operation[(17.6±6.4)ml]was lower than that in the fixation group[(60.6±17.3)ml,(25.3±5.2)ml].The difference was statistically significant(t=2.474,P=0.018;t=4.154,P=0.000).There was no significant difference in operation time,intraoperative blood loss and hospitalization time between the two groups(t=0.133,P=0,895;t=0.551,P=0.312;t=1.259,P=0.700).The range of motion(ROM)(31.4±2.8),muscle strength(22.0±2.5)and final total score(79.5±5.7)of the patients in the replacement group were better than those in the fixation group[(26.7±4.0),(20.0±2.8),(73.5±4.0)].The difference was statistically significant(t=-4.314,P=0.000;t=-2.373,P=0.023;t=-3.812,P=0.000).On the 15th and 30th day after operation,the VAS pain score and Neer score in the replacement group[(2.4±0.5),(1.9±0.4),(85.3±4.8)]were better than those in the fixation group[(2.9±0.6),(2.5±0.5),(81.3±3.5)].The difference was statistically significant(t=2.746,P=0.009;t=3.625,P=0.001;t=-3.034,P=0.004).There was no significant difference in VAS pain score between preoperative and 3 days after operation(t=-0.355,P=0.724;t=-1.744,P=0.089).Conclusion:From the above data of this study,it can be seen that in the surgical treatment of comminuted fracture of proximal humerus with severe osteoporosis in the elderly,There was no significant difference between the two groups in operation time,intraoperative blood loss,hospital stay and constant shoulder joint score(pain and ability of life ADL)between the two groups(P>0.05),and there was no significant difference between the two groups in operation time,intraoperative blood loss,hospital stay and shoulder joint score(pain and ability of life ADL)between the two groups(P>0.05).However,there were significant differences in postoperative drainage,constant shoulder score(ROM,muscle strength and total score),Neer score and long-term VAS pain score between the two groups(P<0.05).Therefore,the use of artificial hemishoulder arthroplasty for comminuted proximal humeral fractures in the elderly can significantly improve the postoperative satisfaction of patients,avoid postoperative joint adhesion and stiffness,and significantly improve the range of motion of shoulder joints.Reduce a series of long-term postoperative pain and complications.It has positive clinical significance. |
PDF Full Text Request