Comparative study of three surgical methods for the treatment of complex proximal humeral fractures in elderly patients / 医学研究生学报

ABSTRACT

Objective There are few comparative researches on open reduction internal fixation, hemishoulder arthroplasty and reverse total shoulder arthroplasty for the treatment of complex proximal humeral fractures. The purpose of this study was to explore the clinical efficacy of three surgical Methods for the treatment of complex proximal humeral fractures.Methods A retrospective study of 55 cases of complex proximal humeral fractures treated in our department from November 2013 to May 2016. According to different surgical Methods , the patients were divided into three groups open reduction internal fixation group of 20 cases (open reduction and internal fixation using locking plate), hemishoulder arthroplasty group of 20 cases (artificial humeral head replacement), reverse total shoulder arthroplasty group of 15 cases (head-glenoid inverted shoulder replacement). Regular postoperative review was done to record the ranges of motion. The function of shoulder joint was evaluated by ASES score, VAS pain score, UCLA score and SST score.Results 6 months after the operation, the internal rotation function of the hemishoulder arthroplasty group\[(49.1±3.3)°\] was better than those of reverse total shoulder arthroplasty group \[(43.7±4.5)°\] and open reduction internal fixation group \[(41.7±5.0)°\], but the external rotation function\[(25.7±5.4)°\] was worse than the other two groups\[(38.0±5.6)°, (39.5±4.6)°\], the differences representing statistical significance(P0.05).Conclusion Three surgical Methods can all be used in the treatment of complex proximal humeral fractures with equivalent efficacy. Reverse total shoulder arthroplasty leads to earlier shoulder joint range of motion, but lacks middle-term and long-term curative effect. Clinicians should take surgical indications and individualization into consideration comprehensively to make the choice among three surgical Methods .