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目的探讨老年肱骨近端骨折的治疗方法及临床疗效。方法2003年1月至2007年2月采用非手术及手术治疗老年肱骨近端骨折56例,男21例,女35例;年龄60～82岁,平均74.2岁,手术组39例,非手术组17例。结果非手术组全部获得随访,随访时间4～20个月,平均8个月;手术组亦全部获得随访,时间10个月～3年,平均1.5年。X线片显示骨折全部愈合,按Neer分类系统分类:无移位骨折8例,二部分骨折33例,其中肱骨外科颈骨折26例,三部分骨折10例,四部分骨折5例。2例非手术组的三、四部分骨折患者骨折愈合时间超过4个月,出现关节僵硬,继发肩关节挛缩。根据Neer评分系统评定疗效:手术组:二部分骨折优良率:82.4%,三、四部分骨折优良率31.6%。结论老年肱骨近端骨折的治疗需根据患者情况选择治疗方法,无移位及二部分骨折经手法复位外固定满意者采用非手术治疗。对于二部分骨折复位后不稳定,三、四部分骨折早期切开复位内固定是有效方法。
Objective To investigate the treatment and clinical efficacy of proximal humerus fractures in the elderly. Methods From January 2003 to February 2007, 56 cases of proximal humerus fractures were treated by non-surgical operation and surgery. There were 21 males and 35 females, aged from 60 to 82 years (average 74.2 years), operation group (39 cases), non-operation group 17 cases. Results All patients in the non-surgical group were followed up for 4-20 months with an average of 8 months. The surgical group was also followed up for 10 months to 3 years with an average of 1.5 years. X-ray films showed complete healing of the fracture. According to Neer classification system, there were 8 cases of no displacement fracture and 33 cases of 2 partial fracture. Among them, 26 cases were neck fracture of humerus, 10 cases of 3 fractures and 5 cases of 4 fractures. Two cases of non-surgical group of three or four fractures of patients with fracture healing time of more than 4 months, there joint stiffness, secondary shoulder contracture. According to the Neer scoring system, the curative effect was evaluated. In the operation group, the excellent and good rate of two-part fracture was 82.4% and the excellent and good rate of three-part and four-part fracture was 31.6%. Conclusion The treatment of proximal humeral fractures in elderly patients should be based on the choice of treatment, no displacement and two fractures by manual reduction of external fixation satisfied with non-surgical treatment. For two fracture instability after the reduction, three, four early fracture reduction and internal fixation is an effective method.