Clinical Effectiveness Analysis PHILOS Locking Plates And Humeral Head Replacement For The Treatment Of Complex Fractures Of The Proximal Humerus In Elderly

Objective :Comparison of the clinical efficacy PHILOS locking plate fixation and hemiarthroplasty for treatment of complex proximal humerus fractures in elderly.Methods : Select Tongling City Hospital Department of orthopedics from 2012 02 months to 2014 02 months,treated 60 patients aged over complex three or four part proximal humeral fractures in operation in 43 patients.Male 18 cases,female 25 cases,age 60 ~ 77 years,average 70.44 years old.The three part fractures in 25 cases,the four part fractures in 18 cases.According to the different methods of treatment were divided into PHILOS group and artificialhumeral head replacement group(HHR group),including 32 cases of PHILOS group,HHR group of 11 cases.PHILOS group 32 cases,age 60 ~ 77 years old(70.53 ±3.869),NEER typethree part fractures in 21 cases,the four part fractures in 11 cases;group HA 11 cases,age 63 ~ 77 years old(70.18 ± 4.644),NEER type three part fractures in 4 cases,the four partfracture 7cases.Record two groups of patients with operation time,operation bleeding volume,the incidence of the use of NEER score and postoperative complications ofpostoperative follow-up to the evaluation of shoulder joint function recovery and the short-term clinical effect.Results:All patients were received outpatient follow-up,follow-up time is similar,the two groups were followed up for 6 ~ 20 months,an average of 11.63 months.Two groups of operation time(80.00±14.97 min and 88.18±8.15min)and intraoperative blood loss(116.56±25.98 ml and 119.09±23.86ml)to compare have no difference(P > 0.05);After treatment,according to NEER grading evaluation of curative effect,PHILOS beloved or group was 96.88%(31/32),the HHR group 100%(11/11),no obvious statistical significance difference comparing the two groups(P > 0.05).Follow-up,by imaging examination found PHILOS beloved or complication rates higher than HHR group,occurred in 2 cases of postoperative plate and acromion impingement,2 cases occurred screw wear into the shoulder joint,but no functional effect,1 case of postoperative displacement of the greater tuberosity,humerus head necrosis occurs in 1 case,postoperative complications in comparison with significant difference(P<0.05).Conclusion:PHILOS beloved or locking plate and artificial humerus head replacement can be used in the treatment of senile complex humeral proximal fractures,on the quality of life and shoulder joint function recovery has no obvious difference,but the HHR group of incidence of postoperative complications was lower than those of PHILOS beloved or group.