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[1]張作君,王俊頎,牛素玲,等.585例肱骨近端骨折臨床療效回顧性研究[J].中醫(yī)正骨,2012,24(09):15-19.
　ZHANG Zuo-jun*,WANG Jun-qi,NIU Su-ling,et al.Retrospective study on the clinical curative effect of 585 cases with proximal humeral fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2012,24(09):15-19.
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585例肱骨近端骨折臨床療效回顧性研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第24卷
期數(shù):
2012年09期
頁碼:
15-19
欄目:
臨床研究
出版日期:
2012-09-30

文章信息/Info

Title:
Retrospective study on the clinical curative effect of 585 cases with proximal humeral fractures
作者:
張作君; 王俊頎; 牛素玲; 介玉嬌; 張川; 昌中孝; 楊林平;  趙明; 許海燕; 夏凱; 寧凡友; 徐榮華
河南省洛陽正骨醫(yī)院,河南 洛陽 471002
Author(s):
ZHANG Zuo-jun*; WANG Jun-qi; NIU Su-ling; JIE Yu-jiao; ZHANG Chuan; CHANG Zhong-xiao; YANG Lin-ping; ZHAO Ming; XU Hai-yan; XIA Kai; NING Fan-you; XU Rong-hua.*
Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
關(guān)鍵詞:
肩骨折 肱骨骨折 回顧性研究 治療; 臨床研究性
Keywords:
Shoulder fractures;  Humeral fractures;  Retrospective studies;  Therapies; investigational
摘要:
目的:通過隨訪肱骨近端骨折大宗臨床病例,比較Neer分型各型骨折中各種治療方法的臨床療效,探討各型骨折的最佳治療方法。方法:將隨訪成功的585例肱骨近端骨折患者按照Neer分型分為4類,即一部分骨折患者、二部分骨折患者、三部分骨折患者和四部分骨折患者。然后根據(jù)每位患者所采用的治療方法進(jìn)行分組,再對各組病人的年齡、性別、Constant-Murley肩關(guān)節(jié)功能評分進(jìn)行統(tǒng)計研究,比較各組患者的臨床療效。結(jié)果:①一部分骨折。25例一部分骨折患者中采用非手術(shù)方法治療者14例(A1組),手法復(fù)位閉合穿針固定者7例(A2組),切開復(fù)位螺釘固定者4例(A3組)。各組患者性別、年齡及治療后Constant-Murley評分比較,差異均無統(tǒng)計學(xué)意義(χ2=1.096,P=0.654; F=0.103,P=0.903; F=3.653,P=0.103)。②二部分骨折。288例二部分骨折患者中采用非手術(shù)方法治療者129例(B1組),手法復(fù)位閉合穿針固定者42例(B2組),切開復(fù)位螺釘固定者33例(B3組),切開復(fù)位鎖定解剖接骨板固定者28例(B4組),切開復(fù)位解剖接骨板固定者34例(B5組),切開復(fù)位三葉草接骨板固定者22例(B6組)。各組患者性別比較,差異有統(tǒng)計學(xué)意義(χ2=12.874,P=0.025); 各組患者年齡比較,差異無統(tǒng)計學(xué)意義(F=7.812,P=0.143); 治療后Constant-Murley評分比較,差異有統(tǒng)計學(xué)意義(F=2.716,P=0.010)。進(jìn)一步兩兩比較,B1組Constant-Murley評分小于B2組、B4組、B6組(P=0.013; P=0.010; P=0.025),B1組與B3組、B5組比較,差異無統(tǒng)計學(xué)意義(P=0.284; P=0.075); B2組Constant-Murley評分大于B5組(P=0.001),B2組與B3組、B4組、B6組比較,差異無統(tǒng)計學(xué)意義(P=0.310; P=0.695; P=0.778); B3組Constant-Murley評分大于B5組(P=0.024),B3組與B4組、B6組比較,差異無統(tǒng)計學(xué)意義(P=0.197; P=0.260); B4組Constant-Murley評分大于B5組(P=0.001),B4組與B6組比較,差異無統(tǒng)計學(xué)意義(P=0.939); B5組Constant-Murley評分小于B6組(P=0.002)。③三部分骨折。172例三部分骨折患者中采用非手術(shù)方法治療者49例(C1組),手法復(fù)位閉合穿針固定者21例(C2組),切開復(fù)位螺釘固定者6例(C3組),切開復(fù)位鎖定解剖接骨板固定者32例(C4組),切開復(fù)位解剖接骨板固定者32例(C5組),切開復(fù)位三葉草接骨板固定者25例(C6組),肱骨頭置換治療者7例(C7組)。各組患者性別比較,差異有統(tǒng)計學(xué)意義(χ2=17.342,P=0.006); 各組患者年齡比較,差異無統(tǒng)計學(xué)意義(F=1.529,P=0.157); 治療后Constant-Murley評分比較,差異有統(tǒng)計學(xué)意義(F=3.720,P=0.000)。進(jìn)一步兩兩比較,C1組Constant-Murley評分小于C2組、C3組、C4組、C5組、C6組、C7組(P=0.012; P=0.001; P=0.021; P=0.032; P=0.017; P=0.000); C2組Constant-Murley評分與C3組、C4組、C5組、C6組比較,差異均無統(tǒng)計學(xué)意義(P=0.055; P=0.271; P=0.406; P=0.073),C2組小于C7組(P=0.003); C3組Constant-Murley評分與C4組、C5組、C6組比較,差異均無統(tǒng)計學(xué)意義(P=0.076; P=0.061; P=0.103),C3組小于C7組(P=0.037); C4組Constant-Murley評分與C5組、C6組比較,差異無統(tǒng)計學(xué)意義(P=0.367; P=0.093),C4組小于C7組(P=0.006); C5組Constant-Murley評分與C6組比較,差異無統(tǒng)計學(xué)意義(P=0.640),C5組小于C7組(P=0.007); C6組Constant-Murley評分小于C7組(P=0.026)。④四部分骨折。100例四部分骨折患者中采用非手術(shù)方法治療者9例(D1組),手法復(fù)位閉合穿針固定者7例(D2組),切開復(fù)位鎖定解剖接骨板固定者21例(D3組),切開復(fù)位解剖接骨板固定者24例(D4組),切開復(fù)位三葉草接骨板固定者24例(D5組),采用肱骨頭置換治療者15例(D6組)。各組患者性別、年齡比較,差異無統(tǒng)計學(xué)意義(χ2=2.657,P=0.773; F=2.310,P=0.062); 治療后Constant-Murley評分比較,差異有統(tǒng)計學(xué)意義(F=13.739,P=0.000)。進(jìn)一步兩兩比較,D1組Constant-Murley評分小于D3組、D4組、D5組、D6組(P=0.000; P=0.001; P=0.001; P=0.000),D1組與D2組比較,差異無統(tǒng)計學(xué)意義(P=0.056); D2組Constant-Murley評分小于D6組(P=0.006),D2組與D3組、D4組、D5組比較,差異無統(tǒng)計學(xué)意義(P=0.085; P=0.399; P=0.406); D3組Constant-Murley評分與D4組、D5組、D6組比較,差異無統(tǒng)計學(xué)意義(P=0.189; P=0.183; P=0.124); D4組Constant-Murley評分小于D6組(P=0.006),D4組與D5組比較,差異無統(tǒng)計學(xué)意義(P=0.985); D5組Constant-Murley評分小于D6組(P=0.006)。結(jié)論:對于肱骨近端骨折治療方法的選擇,應(yīng)根據(jù)患者受傷情況、骨折類型、醫(yī)生的手術(shù)水平、患者的期望值等進(jìn)行綜合考慮。建議一部分骨折以手法復(fù)位閉合穿針固定治療為主; 二部分骨折以手術(shù)切開復(fù)位內(nèi)固定治療為主; 對于三部分骨折和四部分骨折的老年患者,建議行肱骨頭置換手術(shù)。
Abstract:
Objective:To compare the clinical curative effects of various kinds of treatment methods on proximal humeral fractures(PHF)in different Neer classification through following up a large number of clinical cases,so as to explore the best method of treating various kinds of PHF.Methods:Five hundred and eighty-five PHF patients with successful follow-up were divided into 4 types as patients in one-part fractures,patients in two-part fractures,patients in three-part fractures and patients in four-part fractures according to Neer classification.Then the patients were divided into different groups according to the treatment methods,after that,the age,gender and Constant-Murley shoulder function scores of patients in each group were statistically researched and the clinical curative effects were compared among all the groups.Results:①One-part fractures:for the 25 patients with one-part fractures,14 cases(group A1)were administrated with non-surgical method,7 cases(group A2)were administrated with manipulative reduction and pinning fixation and 4 cases(group A3)were administrated with open reduction and screw fixation.There were no statistical differences in gender,age and Constant-Murley scores after treatment among the 3 groups(χ2=1.096,P=0.654; F=0.103,P=0.903; F=3.653,P=0.103).②Two-part fractures:for the 288 patients with two-part fractures,129 cases(group B1)were administrated with non-surgical method,42 cases(group B2)were administrated with manipulative reduction and pinning fixation,33 cases(group B3)were administrated with open reduction and screw fixation,28 cases(group B4)were administrated with open reduction and locking anatomical plate fixation,34 cases(group B5)were administrated with open reduction and anatomical plate fixation and 22 cases(group B6)were administrated with open reduction and clover plate fixation.There was statistical difference in gender among the 6 groups(χ2=12.874,P=0.025); there was no statistical difference in age among the 6 groups(F=7.812,P=0.143)and there was statistical difference in Constant-Murley scores after treatment among the 6 groups(F=2.716,P=0.010).For the further pairwise comparison,Constant-Murley score of group B1 was lower than that of group B2,B4 and B6, respectively(P=0.013,P=0.010,P=0.025),while there was no statistical difference between group B1 and group B3,B5,respectively(P=0.284,P=0.075); Constant-Murley score of group B2 was higher than that of group B5(P=0.001),while there was no statistical difference between group B2 and group B3,B4,B6,respectively(P=0.310,P=0.695,P=0.778); Constant-Murley score of group B3 was higher than that of group B5(P=0.024),while there was no statistical difference between group B3 and group B4,B6,respectively(P=0.197; P=0.260); Constant-Murley score of group B4 was higher than that of group B5(P=0.001),while there was no statistical difference between group B4 and group B6(P=0.939); Constant-Murley score of group B5 was lower than that of group B6(P=0.002).③Three-part fractures:for the 172 patients with three-part fractures,49 cases(group C1)were administrated with non-surgical method,21 cases(group C2)were administrated with manipulative reduction and pinning fixation,6 cases(group C3)were administrated with open reduction and screw fixation,32 cases(group C4)were administrated with open reduction and locking anatomical plate fixation,32 cases(group C5)were administrated with open reduction and anatomical plate fixation,25 cases(group C6)were administrated with open reduction and clover plate fixation and 7 cases(group C7)were administrated with humeral head replacement.There was statistical difference in gender among the 7 groups(χ2=17.342,P=0.006); there was no statistical difference in age among the 7 groups(F=1.529,P=0.157)and there was statistical difference in Constant-Murley scores after treatment among the 7 groups(F=3.720,P=0.000).For the further pairwise comparison,Constant-Murley score of group C1 was lower than that of group C2,C3,C4,C5,C6 and C7,respectively(P=0.012,P=0.001,P=0.021,P=0.032,P=0.017,P=0.000); there was no statistical difference between group C2 and group C3,C4,C5,C6,respectively(P=0.055; P=0.271; P=0.406; P=0.073),while scores of group C2 was lower than that of group C7(P=0.003); there was no statistical difference between group C3 and group C4,C5,C6,respectively(P=0.076,P=0.061,P=0.103),while scores in group C3 was lower than that of group C7(P=0.037); there was no statistical difference in Constant-Murley score between group C4 and group C5,C6,respectively(P=0.367,P=0.093),while scores of group C4 was lower than that of group C7(P=0.006); there was no statistical difference in Constant-Murley score between group C5 and group C6(P=0.640); Constant-Murley score of group C5 and group C6 were lower than that of group C7(P=0.007,P=0.026).④Four-part fractures:for the 100 patients with four-part fractures,9 cases(group D1)were administrated with non-surgical method,7 cases(group D2)were administrated with manipulative reduction and pinning fixation,21 cases(group D3)were administrated with open reduction and locking anatomical plate, fixation,24 cases(group D4)were administrated with open reduction and anatomical plate fixation,24 cases(group D5)were administrated with open reduction and clover plate fixation and 15 cases(group D6)were administrated with humeral head replacement.There were no statistical differences in gender and age among the 6 groups(χ2=2.657,P=0.773; F=2.310,P=0.062); there was statistical difference in Constant-Murley scores after treatment among the 6 groups(F=13.739,P=0.000).For the further pairwise comparison,Constant-Murley score of group D1 was lower than that of group D3,D4,D5 and D6,respectively(P=0.000,P=0.001,P=0.001,P=0.000),while there was no statistical difference between group D1 and group D2(P=0.056); Constant-Murley score of group D2 was lower than that of group D6(P=0.006),while there was no statistical difference between group D2 and group D3,D4,D5,respectively(P=0.085; P=0.399; P=0.406); there was no statistical difference between group D3 and group D4,D5,D6,respectively(P=0.189,P=0.183,P=0.124); Constant-Murley score of group D4 was lower than that of group D6(P=0.006),while there was no statistical difference between group D4 and group D5(P=0.985); Constant-Murley score of group D5 was lower than that of group D6(P=0.006).Conclusion:The method of treating proximal humeral fractures shall be chosen according to the patient's condition,classification of fracture,surgeon's ability,patient's expected value,etc.We suggest that most One-part fractures should be treated with manipulative reduction and pinning fixation,open reduction and internal fixation could be mainly used in treating two-part fractures,and three-part and four-part fractures in the aged patients should be treated with humeral head replacement.

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備注/Memo

備注/Memo:
2011-12-15收稿 2012-05-03修回
更新日期/Last Update: 2012-09-30