Department of Orthopaedics, Elkerliek Hospital, Helmond, The Netherlands.
Clin Orthop Relat Res. 2012 Dec;470(12):3483-91. doi: 10.1007/s11999-012-2531-0. Epub 2012 Aug 16.
Four-part fractures of the proximal humerus account for 3% of all humeral fractures and are regarded as the most difficult fractures to treat in the elderly. Various authors recommend nonoperative treatment or hemiarthroplasty, but the literature is unclear regarding which provides better quality of life and function.
QUESTIONS/PURPOSES: We therefore performed a randomized controlled trial to compare (1) function, (2) strength, and (3) pain and disability in patients 65 years and older with four-part humeral fractures treated either nonoperatively or with hemiarthroplasty.
We randomly allocated 50 patients to one of the two approaches. There were no differences in patient demographics between the two groups. The Constant-Murley score was the primary outcome measure. Secondary outcome measures were the Simple Shoulder Test, abduction strength test as measured by a myometer, and VAS scores for pain and disability. All patients were assessed at 12 months.
We found no between-group differences in Constant-Murley and Simple Shoulder Test scores at 3- and 12-months followup. Abduction strength was better at 3 and 12 months in the nonoperatively treated group although the nonoperatively treated patients experienced more pain at 3 months; this difference could not be detected after 12 months.
We observed no clear benefits in treating patients 65 years or older with four-part fractures of the proximal humerus with either hemiarthroplasty or nonoperative treatment.
Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
肱骨近端四部分骨折占所有肱骨骨折的 3%，被认为是老年人最难治疗的骨折。不同的作者建议非手术治疗或半关节成形术，但文献对于哪种方法能提供更好的生活质量和功能并不清楚。
问题/目的：因此，我们进行了一项随机对照试验，比较（1）功能，（2）力量，以及（3）65 岁及以上四部分肱骨骨折患者接受非手术或半关节成形术治疗后的疼痛和残疾。
我们将 50 名患者随机分配到两种方法中的一种。两组患者的人口统计学特征无差异。Constant-Murley 评分是主要的结果测量指标。次要结果测量指标包括简易肩部测试、测角器测量的外展力量测试以及疼痛和残疾的 VAS 评分。所有患者均在 12 个月时进行评估。
我们发现，在 3 个月和 12 个月的随访中，Constant-Murley 和简易肩部测试评分在两组之间没有差异。尽管非手术治疗组在 3 个月和 12 个月时的外展力量更好，但非手术治疗组的患者在 3 个月时疼痛更严重；12 个月后这种差异无法检测到。
我们观察到，对于 65 岁及以上的四部分肱骨近端骨折患者，用半关节成形术或非手术治疗都没有明显的优势。
I 级，治疗研究。有关证据水平的完整描述，请参阅作者说明。
