老年肱骨近端3-4部分骨折手术与保守治疗的疗效和费用分析  

Comparison of clinical result and total costs between surgical and non-operative treatment for 3 and 4 part proximal humeral fracture in the elderly

作　　者：李宇能[1] 刘昊楠 朱仕文[1] 苏永刚[1] 毛玉江[1] 周萌 王颢 吴新宝[1] Li Yuneng;Liu Haonan;Zhu Shiwen;Su Yonggang;Mao Yujiang;Zhou Meng;Wang Hao;Wu Xinbao(Department of Orthopedics&Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopedics,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Orthopedics Surgery,GuangDong Provincial People′s Hospital,Guangzhou 510080,China)

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]国家儿童医学中心首都医科大学附属北京儿童医院骨科,100045 [3]广东省人民医院(广东省医学科学院)骨科中心,广州510080

出　　处：《中华损伤与修复杂志（电子版）》2021年第5期411-416,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：北京市属医院科研培育计划(PX2019016)。

摘　　要：目的比较老年肱骨近端骨折手术与保守治疗的临床疗效和总体费用,总结临床经验。方法收集2019年1月至2020年3月于北京积水潭医院就诊的72例老年肱骨近端3-4部分骨折患者的临床资料,根据治疗方式不同将患者分为手术组和保守组,其中手术组患者39例,住院后接受切开复位内固定术;保守组患者33例,给予患肢制动、肢具固定等非手术处理。治疗结束后通过电话和门诊复查的方式对患者进行定期随访。采用Constant-murley评分和DASH调查表评估患者肩关节和上肢整体功能,采用欧洲五维健康量表(EQ-5D)评估患者生活质量,根据北京积水潭医院医疗记录和标准费用法统计患者伤后总体费用。数据比较采用t检验、秩和检验以及卡方检验。结果所有患者均完成2年随访。随访期间手术组和保守组患者并发症发生率分别为28.2%和21.2%,差异无统计学意义(χ^(2)=0.466,P=0.495)。术后1年手术组和保守组患者肩关节功能分别为(76.1±10.5)分和(68.6±11.7)分,差异有统计学意义(t=8.772,P<0.05),上肢整体功能分别为(26.7±20.5)分和(32.1±11.7)分,差异有统计学意义(t=8.331,P<0.05),生活质量分别为(0.78±0.21)分和(0.72±0.21)分,差异有统计学意义(t=9.033,P<0.05),手术组均明显优于保守组。术后2年手术组和保守组患者肩关节功能分别为(78.3±10.3)分和(69.6±8.5)分,差异有统计学意义(t=9.031,P<0.05),上肢整体功能分别为(24.2±19.3)和(31.1±11.5)分,差异有统计学意义(t=9.309,P<0.05),生活质量分别为(0.79±0.19)分和(0.76±0.16)分,差异无统计学意义(t=1.201,P=0.102)。末次随访时手术组和保守组患者总体费用分别为52171.2元和11108.5元,手术组明显高于保守组,差异有统计学意义(Z=8.201,P<0.05)。结论老年肱骨近端3-4部分骨折手术和保守治疗均可取得良好的临床疗效。与保守治疗相比切开复位内固定术更有利于患者早期关节功能恢复和生活�Objective To compare the clinical effect and costs of open reduction with internal fixation(ORIF)and conservative treatment for 3 and 4 part proximal humeral fractures.Methods The data of 72 elderly patients with 3 and 4 part proximal humeral fractures were collected in this study from January 2019 to March 2020.According to the treatment plan the patients were divided into operative group(39 cases)and non-operative group(33 cases)respectively.The Constant-murley scores and DASH(disabilities of the arm,should and hand)questionnaire were applied to evaluate the function of shoulder joint and upper limbs.The EuroQol 5 dimensions scores(EQ-5D)were applied to evaluate the quality of life after injury.The total costs of each group were collected by medical record and standard methods.Results All the patients completed more than 2 years follow-up.Compared to non-operative group the incidence rate of complication was higher in operation group,the difference was not statistically significant(28.2%vs.21.2%,χ^(2)=0.466,P=0.495).In 1 year follow-up the Constant-murley scale in operative and non-operative group was(76.1±10.5)pointsand(68.6±11.7)points,the difference was statistically significant(t=8.772,P<0.05),Dash sacel was(26.7±20.5)points and(32.1±11.7)points,repectively,the difference was statistically significant(t=8.331,P<0.05),and EQ-5D scale was(0.78±0.21)points and(0.72±0.21)points,the difference was statistically significant(t=9.033,P<0.05).All the outcome favored ORIF.After 2 years Constant-murley scale in operative and non-operative group was(78.3±10.3)points and(69.6±8.5)points,the difference was statistically significant(t=8.772,P<0.05),Dash sacel was(24.2±19.3)points and(31.1±11.5)points,repectively,the difference was statistically significant(t=8.331,P<0.05),and EQ-5D scale was(0.79±0.19)points and(0.76±0.16)points,repectively,the difference was statistically significant(t=9.033,P<0.05).At the last follow-up the total costs for operative and non-operative group were 52171.2 yuan and 11108.5 yuan

关 键 词：肱骨骨折 骨折固定术 保守治疗 临床疗效 

分 类 号：R683.42[医药卫生—骨科学]