Department of Orthopedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland.
Department of Orthopedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland.
J Shoulder Elbow Surg. 2020 Jun;29(6):1127-1135. doi: 10.1016/j.jse.2019.11.006. Epub 2020 Feb 10.
We modified our treatment algorithm for proximal humeral fractures in elderly patients in 2013 to a more conservative approach avoiding locking plates. This study assesses the impact of this change on patient self-dependence.
We carried out an observational comparative study including both retrospectively and prospectively collected data. For the former, 147 isolated proximal humeral fracture patients older than 65 years were treated between 2011 and 2013 at our hospital and included in a historical group. The revised treatment algorithm was applied in a similar non-concurrent, comparative patient group (n = 160) prospectively enrolled between 2015 and 2017. The primary outcome was any loss of self-dependence, with secondary outcomes including documentation of shoulder functional scores, quality of life, and adverse events.
Historical and prospective patients had similar baseline characteristics. Nonoperative treatment was performed in 53 historical patients (36%) and 83 prospective patients (78%). Prospective patients were 1.6 times less likely to lose some level of self-dependence (risk ratio, 0.62; 95% confidence interval, 0.25-1.5; P = .292), and the local adverse event risk dropped from 12.2% to 5.7% (P = .078). Mean shoulder function and quality of life were similar between the 2 groups.
By applying our revised algorithm, a higher proportion of elderly patients maintained their premorbid level of self-dependence and returned to their previous social environment.
2013 年，我们修改了老年患者肱骨近端骨折的治疗方案，转为更保守的方法，避免使用锁定钢板。本研究评估了这一改变对患者自理能力的影响。
我们进行了一项观察性对比研究，包括回顾性和前瞻性收集的数据。前者纳入了 2011 年至 2013 年在我院治疗的 147 例年龄大于 65 岁的单纯肱骨近端骨折患者，并将其纳入历史组。修订后的治疗方案应用于类似的非同期、前瞻性患者组（n=160），该组患者于 2015 年至 2017 年期间入组。主要结局为自理能力的任何丧失，次要结局包括肩关节功能评分、生活质量和不良事件的记录。
历史组和前瞻性组患者的基线特征相似。53 例（36%）历史组患者和 83 例（78%）前瞻性组患者接受了非手术治疗。前瞻性组患者丧失某种程度自理能力的风险降低了 1.6 倍（风险比，0.62；95%置信区间，0.25-1.5；P=0.292），局部不良事件风险从 12.2%降至 5.7%（P=0.078）。两组患者的肩关节功能和生活质量评分相似。
应用我们的修订方案后，更多老年患者维持了发病前的自理能力，回归到了先前的社会环境。
