A Clinical Analysis Of Locking Proximal Humerus Plate Versus Humeral Head Replacement For The Treatment Of The Four-part Proximal Humeral Fractures In The Elderly

Objective To evaluate the clinical effect of LPHP internal fixation and artificial humeral head replacement in the treatment of Neer four-part proximal humeral fractures in the elderly.Methods Patients over 60 years of age with four-part Neer fractures of the proximal humerus who underwent surgical treatment at ningxia medical university general hospital from January 2017 to January 2019 were selected.here were 17 males and 26 females,and the age distribution ranged from 60 to 73 years old,with an average age of 66.42 years old.None of the patients had a history of shoulder stiffness and decreased muscle strength before surgery.According to different surgical methods,43 patients were divided into locking plate internal fixation group(LPHP group)and artificial humeral head replacement group(HHR group).There were 20 cases in LPHP group with age distribution range of 60-69 years old(65.93±6.42 years old),and 23 cases in HHR group with age distribution range of 64-73 years old(67.18±3.98 years old).Preoperative comprehensive evaluation of the patient’s condition was conducted by the same group of physicians to formulate and implement the surgical plan,Postoperative patients were instructed to perform primary and passive functional exercise of shoulder joint.X-ray of shoulder joint was reviewed one month after surgery and follow-up was conducted for 6-14 months after treatment,By recording the age,gender,operation time,intraoperative blood loss,Neer shoulder joint function score at 6 months after surgery and theincidence of surgical complications of the two groups of patients,the recovery status and surgical effect of the shoulder joint of the patients were determined.Results Two groups of patients were postoperative follow-up,6-14 months follow-up time,compared two groups of operation time(LPHP groups: 94.35 ± 28.85 min,HHR groups: 72.28 ± 11.37 min),intraoperative blood loss(LPHP groups: 246.45± 33.68 ml,HHR groups: 211.24 ± 45.75 ml)and 6 months after Neer shoulder joint function score(LPHP groups: 71.67 ± 5.98,HHR groups: 86.44 ±3.56),compared two groups of data P values are less than 0.05,the difference was statistically significant.6 months after the operation,the excellent and good rates of Neer score in the two groups were compared(65.00% in the LPHP group and 95.65% in the HHR group).The postoperative complications in the two groups were compared.There were 1 cases of shoulder joint stiffness,1 case of subacromial impingement and 2 cases of humeral head necrosis in the locking plate group,while no significant postoperative complications were observed in the artificial humeral head replacement group.The difference between the two groups was statistically significant(P <0.05).Conclusion LPHP locking plate internal fixation and artificial humeral head replacement are both effective surgical options for four-part fractures of the proximal humerus in the elderly.Comparing the two surgical methods,artificial humeral head replacement is superior to LPHP locking plate in operation time,intraoperative blood loss,Neer shoulder joint function score and surgical complication rate.Therefore,artificial humeral head replacement is the preferred treatment for four-part proximal humeral fractures in the elderly.