非手术治疗与锁定钢板内固定治疗老年肱骨近端NeerⅢⅣ型骨折的疗效比较

本文格式为Word版，下载可任意编辑——非手术治疗与锁定钢板内固定治疗老年肱骨近端NeerⅢⅣ型骨折的疗效比较

目的比較非手术治疗与锁定钢板内固定治疗老年肱骨近端NeerⅢ、Ⅳ型骨折的疗效差异。方法70例老年肱骨近端NeerⅢ、Ⅳ型骨折患者，按随机数字表法分为保守组和手术组，每组35例。保守组患者行手法复位小夹板外固定治疗，手术组患者行锁定钢板内固定治疗。对比两组的治疗效果。结果两组骨折愈合时间对比差异无统计学意义（P0.05）;手术组住院时间（12.20±0.65）d长于保守组的（7.60±0.60）d，并发症发生率14.29%低于保守组的51.43%，差异均具有统计学意义（P0.05）。治疗

6个月后手术组的优良率与保守组对比差异无统计学意义（P0.05）。治疗6个月后手术组Constant-Murley功能评分中疼痛、日常活动、活动度、肌力评分与保守组对比差异均无统计学意义（P0.05）。

结论锁定钢板内固定治疗老年肱骨近端NeerⅢ、Ⅳ型骨折固定稳当，利于早期功能磨练，但存在确定风险，而保守治疗治疗费用低，且肩关节功能改善效果与手术治疗相当，医生应根据患者实际处境举行合理选择。

肱骨近端NeerⅢ、Ⅳ型骨折;锁定钢板内固定;保守治疗;肩关节功能;老年

DOI：10.14163/ki.11-5547/r.2022.12.013

ObjectiveTocomparetheefficacydifferenceofnon-operativetherapyandlockingplateinternalfixationinthetreatmentofNeerⅢandⅣtypeproximalhumerusfracturesintheelderly.MethodsAtotalof70elderlypatientswithNeerⅢandⅣtypeproximalhumerusfracturesweredividedbyrandomnumbertablemethodintoconservativegroupandoperativegroup，with35casesineachgroup.Theconservativegroupreceivedmanualreductionandsmallsplintexternalfixationtherapy，andtheoperativegroupreceivedlockingplateinternalfixation.Thetreatmenteffectintwogroupswascomparedbetweenthetwogroups.ResultsBothgroupshadnostatisticallysignificantdifferenceinfracturehealingtime（P0.05）.Theoperativegrouphadlongerhospitalizationtimeas（12.20±0.65）dthan（7.60±0.60）dinconservativegroup，andlowerincidenceofadversereactionsas14.29%than51.43%intheconservativegroup.Theirdifferencewasstatisticallysignificant（P0.05）.After6monthsoftreatment，theoperativegrouphadnostatisticallysignificantdifferenceinexcellentratecomparingwithconservativegroup（P0.05）.After6monthsoftreatment，theoperativegrouphadnostatisticallysignificantdifferenceinConstant-Murleyfunctionscoreofpain，dailyactivity，activityandmusclestrength（P0.05）.ConclusionLockingplateinternalfixationforthetreatmentofNeerⅢandⅣtypeproximalhumerusfracturesisreliableandisconducivetoearlyfunctionalexercise，butthereisacertainrisk.Whilethecostofconservativetreatmentislow，andtheeffectofshoulderjointfunctionimprovementisequaltothatofoperativetherapy.Thedoctorshouldmakereasonablechoiceaccordingtotheactualsituationofthepatients.

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