【摘要】 目的 比較非手术治疗与锁定钢板内固定治疗老年肱骨近端NeerⅢ、Ⅳ型骨折的疗效差异。方法 70例老年肱骨近端NeerⅢ、Ⅳ型骨折患者， 按随机数字表法分为保守组和手术组， 每组35例。保守组患者行手法复位小夹板外固定治疗， 手术组患者行锁定钢板内固定治疗。比较两组的治疗效果。结果 两组骨折愈合时间比较差异无统计学意义（P>0.05）;手术组住院时间（12.20±0.65）d长于保守组的（7.60±0.60）d， 并发症发生率14.29%低于保守组的51.43%， 差异均具有统计学意义（P<0.05）。治疗
6个月后手术组的优良率与保守组比较差异无统计学意义（P>0.05）。治疗6个月后手术组Constant-Murley功能评分中疼痛、日常活动、活动度、肌力评分与保守组比较差异均无统计学意义（P>0.05）。
结论 锁定钢板内固定治疗老年肱骨近端NeerⅢ、Ⅳ型骨折固定可靠， 利于早期功能锻炼， 但存在一定风险， 而保守治疗治疗费用低， 且肩关节功能改善效果与手术治疗相当， 医生应根据患者实际情况进行合理选择。
【关键词】 肱骨近端NeerⅢ、Ⅳ型骨折;锁定钢板内固定;保守治疗;肩关节功能;老年
DOI：10.14163/j.cnki.11-5547/r.2018.12.013
【Abstract】 Objective To compare the efficacy difference of non-operative therapy and locking plate internal fixation in the treatment of Neer Ⅲ and Ⅳ type proximal humerus fractures in the elderly. Methods A total of 70 elderly patients with Neer Ⅲ and Ⅳ type proximal humerus fractures were divided by random number table method into conservative group and operative group， with 35 cases in each group. The conservative group received manual reduction and small splint external fixation therapy， and the operative group received locking plate internal fixation. The treatment effect in two groups was compared between the two groups. Results Both groups had no statistically significant difference in fracture healing time （P>0.05）. The operative group had longer hospitalization time as （12.20±0.65） d than （7.60±0.60） d in conservative group， and lower incidence of adverse reactions as 14.29% than 51.43% in the conservative group. Their difference was statistically significant （P<0.05）. After 6 months of treatment， the operative group had no statistically significant difference in excellent rate comparing with conservative group （P>0.05）. After 6 months of treatment， the operative group had no statistically significant difference in Constant-Murley function score of pain， daily activity， activity and muscle strength （P>0.05）. Conclusion Locking plate internal fixation for the treatment of Neer Ⅲ and Ⅳ type proximal humerus fractures is reliable and is conducive to early functional exercise， but there is a certain risk. While the cost of conservative treatment is low， and the effect of shoulder joint function improvement is equal to that of operative therapy. The doctor should make reasonable choice according to the actual situation of the patients.
【Key words】 NeerⅢ and Ⅳ type proximal humerus fractures; Locking plate internal fixation; Conservative therapy; Shoulder joint function; Elderly