老年肱骨近端骨折后肩关节功能恢复的影响因素分析  

Analysis of factors influencing shoulder function recovery after proximal humeral fractures in the aged

作　　者：刘凯 尚如国 梁志超 胡建炜 喻永新 LIU Kai, SHANG Ruguo, LIANG Zhichao, HU Jianwei, YU Yongxin(Guangzhou Orthopedic Hospital, Guangzhou 510030, Guangdong, China)

机构地区：[1]广东省广州市正骨医院,广东广州510030

出　　处：《中医正骨》2018年第9期39-41,52,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：广州市越秀区科技计划项目(2015-WS-026)

摘　　要：目的:探讨老年肱骨近端骨折后肩关节功能恢复的影响因素。方法:收集2015年8月至2017年3月在广东省广州市正骨医院治疗的老年肱骨近端骨折患者的病例资料,包括患者的性别、年龄、骨折分型、治疗方法、骨折愈合情况、并发症、功能锻炼情况及肩关节功能评分。骨折分型采用Neer分型标准,骨折愈合情况根据影像学标准评定,肩关节功能评价采用Constant-Murley评分。结果:共收集到122例获得随访患者的病例资料,随访时间12～19个月,中位数14个月。男50例,女72例。年龄≥70岁69例,年龄<70岁53例。肱骨近端骨折Neer分型,Ⅰ型21例、Ⅱ型42例、Ⅲ型43例、Ⅳ型16例。非手术治疗80例,手术治疗42例。治疗后遵医嘱进行功能锻炼55例,未进行功能锻炼67例。骨折愈合情况,优55例、良38例、可24例、差5例。随访期间15例患者出现并发症,其中皮肤过敏或溃烂5例、切口感染2例、内固定失效1例、肱骨头坏死2例、骨折畸形愈合5例。男性组与女性组、年龄≥70岁组与年龄<70岁组、非手术治疗组与手术治疗组的肩关节功能评分比较,组间差异均无统计学意义[(75. 94±6. 03)分,(77. 04±5. 83)分,t=1. 012,P=0. 314;(75. 91±5. 99)分,(77. 47±5. 75)分,t=1. 450,P=0. 150;(76. 39±5. 95)分,(76. 98±5. 89)分,t=-0. 521,P=0. 603];骨折Neer分型为Ⅰ型和Ⅱ型患者的肩关节功能评分高于Ⅲ型和Ⅳ型患者[(79. 94±4. 26)分,(73. 02±5. 33)分,t=7. 946,P=0. 000];有并发症患者的肩关节功能评分低于无并发症患者[(72. 20±4. 68)分,(77. 21±5. 82)分,t=3. 184,P=0. 002];骨折愈合情况为优、良患者的肩关节功能评分高于可、差患者[(78. 77±5. 74)分,(72. 45±4. 41)分,t=4. 678,P=0. 000];遵医嘱进行功能锻炼患者的肩关节功能评分高于未遵医嘱进行功能锻炼的患者[(78. 88±5. 36)分,(73. 80±5. 36)分,t=-5. 206,P=0. 000]。结论:骨折分型、并发症、骨折愈合情况及功能锻炼情况,是Objective： To explore the factors influencing shoulder function recovery after proximal humeral fractures in the aged. Methods：The medical records of patients with proximal humeral fractures who were treated in Guangzhou Orthopedic Hospital from August 2015 to March 2017 were collected. The collected clinical data included gender, age, classification of fractures, treatment, fracture healing, complications, functional exercise and shoulder function scores. The fractures was classified according to Neer classification standard, and the fracture healing was assessed according to imaging standard, and the shoulder function was evaluated by using Constant - Murley scores. Results ：The clinical data of 122 patients were collected. The patients were followed up for 12 - 19 months with a median of 14 months and they consisted of 50 males and 72 females. Sixty - nine patients were ≥70 years old and 53 patients were 〈 70 years old. The factures be- longed to types Ⅰ （21）, Ⅱ （42）, Ⅲ （43）and Ⅳ （16）according to Neer classification standard of proximal humeral fractures. Non -operative treatment was performed on 80 patients and operative treatment was performed on 42 patients. Fifty five patients performed functional exer- cises by doctor＇ s advice after the treatment and 67 patients didn＇t perform functional exercises. Fiftyfive patients obtained an excellent result of fracture healing,38 good ,24 fair and 5 poor. The complications including skin allergy or ulceration （5）, incision infection（ 2 ）, failed internal fixation（ 1 ）, humeral head necrosis（ 2 ）and fracture malunion（ 5 ）were found during the follow- up period. There was no sta- tistical difference in shoulder function scores between male patients and female patients, and between patients ≥70 years and patients 〈 70 years and between non -operative treatment group and operative treatment group （75.94 ＋/-6.03 vs 77.04 ＋/-5.83 points, t = 1. 012, P =0.314;75.91 ＋/-5.99 vs 77.47 ＋/-5.75 points,t=1.4

关 键 词：肩骨折 肱骨骨折 肩关节 功能恢复 影响因素分析 老年人 

分 类 号：R683[医药卫生—骨科学]