切开复位内固定术治疗老年人肱骨外科颈骨折的病例对照研究

目的 ：总结肱骨外科颈骨折临床治疗经验和体会。方法 ：选择2008年5月至2013年5月治疗的60岁以上（含60岁）老年肱骨外科颈骨折患者295例,分为两组。手术组：共139例,男58例,女81例;年龄60~91岁,平均（70.3±6.5）岁;伤后30 min~15 d入院,平均（19.7±18.4）h;应用切开复位钢板内固定术治疗。小夹板组：共156例,男75例,女81例;年龄60~98岁,平均（70.6±7.0）岁;伤后1 h~15 d入院,平均（20.2±20.1）h;应用手法复位后小夹板固定治疗。治疗后按Neer肩关节功能评分在疼痛、功能、运动限制、解剖复位及总分改善方面观察评分。结果：295例均获随访,时间5~20个月,平均13.2个月。以Neer肩关节功能评分评价疗效：切开复位内固定术组总分91.48±7.46,小夹板组总分85.62±7.61,切开复位内固定术组疗效优于小夹板组。结论：切开复位内固定术在治疗老年肱骨外科颈骨折与小夹板外固定相比,具有减少患者疼痛、促进功能恢复、达到良好解剖复位及获得较好的整体效果的优势。

Case-control study on open reduction and internal fixation for the treatment of humeral surgical neck fracture in aged patients

Objective: To summarize clinical experiences of open reduction and internal fixation for the treatment of humeral surgical neck fractures.Methods: From May 2008 to May 2013,295 patients with humeral surgical neck fractures were divided into two groups:operation group and small splint group. In the operation group:there were 139 cases including 58 males and 81 females,treated with open reduction and locking plate fixation. The mean age of the patients was(70.3±6.5) years old (ranged from 60 to 91 years old). The interval from injury to hospital ranged from 30 min to 15 days,with an average of (19.7±18.4) hours. In the small splint group:there were 156 cases including 75 males and 81 females,treated with manipulative reduction and small splint external fixation. The mean age of the patients was (70.6±7.0) years old (ranged from 60 to 98 years old). The interval from injury to hospital ranged from 1 hour to 15 days,with an average of(20.2±20.1) hours. The therapeutic effects were evaluated with shoulder pain,function,activity,anatomical indicators and total score according to Neer Score after treatment.Results: All the patients were followed up,and the duration ranged from 5 to 20 months,with an average of 13.2 months. According to Neer Score,the total score of patients in the operation group was 91.48±7.46; while in the small splint group,the score was 85.62±7.61;the score of patients in the operation group was higher than that of small splint group.Conclusion: Compared with small splint external fixation,the method of open reduction and internal fixation for the treatment of humeral surgical neck fracture in aged patients has several advantages such as reducing pain,improving functional recovery,getting a better anatomical position and better clinical effects.