Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
J Orthop Trauma. 2011 Oct;25(10):612-7. doi: 10.1097/BOT.0b013e3182008df8.
Proximal humerus fractures are common in the setting of osteopenia and osteoporosis and can often be treated nonoperatively. There are few studies that evaluate the long-term outcomes of nonoperative treatment of these fractures. We performed a systematic review of the literature to examine the results of nonoperative treatment of proximal humerus fractures.
The PubMed search engine and EMBASE database were used. Inclusion criteria were: 1) proximal humerus fractures resulting from trauma; 2) age older than 18 years; 3) more than 15 patients in the study; 4) greater than 1 year follow-up; 5) at least one relevant functional outcome score; and 6) a quality outcome score of at least a 5 of 10 according to previously published scoring system.
We identified 12 studies that included 650 patients with a mean age of 65.0 years (range, 51-75 years) and a mean follow-up of 45.7 months (range, 12-120 months). There were 317 one-part fractures, 165 two-part fractures, 137 three-part fractures, and 31 four-part fractures. The rate of radiographic union was 98% and the complication rate 13%. The average range of motion reported in five studies was 139° forward flexion, 48° external rotation, and 52° internal rotation. The average Constant score reported in six studies was 74 (range, 55-81). Varus malunion was the most common complication reported, whereas avascular necrosis was uncommon (13 cases).
We conclude that our systematic review of the literature on the nonoperative treatment of proximal humerus fractures demonstrates high rates of radiographic healing, good functional outcomes, and a modest complication rate.
骨质疏松症和骨质减少症患者中常发生肱骨近端骨折，这些骨折通常可以非手术治疗。很少有研究评估这些骨折非手术治疗的长期结果。我们对文献进行了系统回顾，以检查肱骨近端骨折非手术治疗的结果。
使用 PubMed 搜索引擎和 EMBASE 数据库。纳入标准为：1）创伤引起的肱骨近端骨折；2）年龄大于 18 岁；3）研究中患者超过 15 例；4）随访时间大于 1 年；5）至少有一个相关的功能结局评分；6）根据先前发表的评分系统，质量结局评分为 10 分中的至少 5 分。
我们确定了 12 项研究，共纳入 650 例患者，平均年龄为 65.0 岁（范围 51-75 岁），平均随访时间为 45.7 个月（范围 12-120 个月）。有 317 例 1 部分骨折、165 例 2 部分骨折、137 例 3 部分骨折和 31 例 4 部分骨折。影像学愈合率为 98%，并发症发生率为 13%。5 项研究报告的平均活动度为 139°前屈、48°外旋和 52°内旋。6 项研究报告的平均 Constant 评分为 74 分（范围 55-81 分）。内翻畸形愈合是最常见的并发症，而缺血性坏死则不常见（13 例）。
我们的系统回顾文献表明，肱骨近端骨折非手术治疗的影像学愈合率高、功能结局良好、并发症发生率适中。
