Royal Infirmary of Edinburgh, Edinburgh Orthopaedic Trauma Unit, 51 Little France Crescent, Edinburgh, EH16 4SU, UK.
Bone Joint J. 2014 Jul;96-B(7):970-7. doi: 10.1302/0301-620X.96B7.32894.
This study describes the epidemiology and outcome of 637 proximal humeral fractures in 629 elderly (≥ 65 years old) patients. Most were either minimally displaced (n = 278, 44%) or two-part fractures (n = 250, 39%) that predominantly occurred in women (n = 525, 82%) after a simple fall (n = 604, 95%), who lived independently in their own home (n = 560, 88%), and one in ten sustained a concomitant fracture (n = 76, 11.9%). The rate of mortality at one year was 10%, with the only independent predictor of survival being whether the patient lived in their own home (p = 0.025). Many factors associated with the patient's social independence significantly influenced the age and gender adjusted Constant score one year after the fracture. More than a quarter of the patients had a poor functional outcome, with those patients not living in their own home (p = 0.04), participating in recreational activities (p = 0.01), able to perform their own shopping (p < 0.001), or able to dress themselves (p = 0.02) being at a significantly increased risk of a poor outcome, which was independent of the severity of the fracture (p = 0.001). A poor functional outcome after a proximal humeral fracture is not independently influenced by age in the elderly, and factors associated with social independence are more predictive of outcome.
本研究描述了 629 名 65 岁以上老年患者的 637 例肱骨近端骨折的流行病学和转归。大多数患者骨折为轻度移位（n = 278，44%）或二部分骨折（n = 250，39%），主要发生在女性（n = 525，82%），且多为单纯跌倒（n = 604，95%）所致，这些患者生活能自理，居住在自己家中（n = 560，88%），十分之一的患者伴有其他骨折（n = 76，11.9%）。一年的死亡率为 10%，唯一独立的生存预测因素是患者是否居住在自己家中（p = 0.025）。与患者社会独立性相关的许多因素显著影响了骨折一年后的年龄和性别调整后的 Constant 评分。超过四分之一的患者功能预后较差，未居住在自己家中（p = 0.04）、不参加娱乐活动（p = 0.01）、无法独立购物（p < 0.001）或无法独立穿衣（p = 0.02）的患者功能预后不良的风险显著增加，这与骨折严重程度无关（p = 0.001）。在老年人中，肱骨近端骨折后的功能预后与年龄无关，而与社会独立性相关的因素是预后的更重要预测因素。
