Comparison of clinical result and total costs between surgical and non-operative treatment for 3 and 4 part proximal humeral fracture in the elderly

doi:10.3877/cma.j.issn.1673-9450.2021.05.007

Abstract

Abstract:

Objective

To compare the clinical effect and costs of open reduction with internal fixation (ORIF) and conservative treatment for 3 and 4 part proximal humeral fractures.

Methods

The data of 72 elderly patients with 3 and 4 part proximal humeral fractures were collected in this study from January 2019 to March 2020. According to the treatment plan the patients were divided into operative group (39 cases) and non-operative group (33 cases) respectively. The Constant-murley scores and DASH (disabilities of the arm, should and hand) questionnaire were applied to evaluate the function of shoulder joint and upper limbs. The EuroQol 5 dimensions scores (EQ-5D) were applied to evaluate the quality of life after injury. The total costs of each group were collected by medical record and standard methods.

Results

All the patients completed more than 2 years follow-up. Compared to non-operative group the incidence rate of complication was higher in operation group, the difference was not statistically significant (28.2% vs. 21.2%, χ²=0.466, P=0.495). In 1 year follow-up the Constant-murley scale in operative and non-operative group was (76.1±10.5) pointsand (68.6±11.7) points, the difference was statistically significant(t=8.772, P<0.05), Dash sacel was (26.7±20.5) points and (32.1±11.7) points, repectively, the difference was statistically significant(t=8.331, P<0.05), and EQ-5D scale was (0.78±0.21) points and (0.72±0.21) points, the difference was statistically significant(t=9.033, P<0.05). All the outcome favored ORIF. After 2 years Constant-murley scale in operative and non-operative group was (78.3±10.3) points and (69.6±8.5) points, the difference was statistically significant(t=8.772, P<0.05), Dash sacel was (24.2±19.3) points and (31.1±11.5) points, repectively, the difference was statistically significant (t=8.331, P<0.05), and EQ-5D scale was(0.79±0.19)points and (0.76±0.16) points, repectively, the difference was statistically significant (t=9.033, P<0.05). At the last follow-up the total costs for operative and non-operative group were 52 171.2 yuan and 11 108.5 yuan, the difference was statistically significant(Z=8.201, P<0.05).

Conclusion

Both operation and conservative treatment can provide satisfactory clinical effect for elderly patients with 3 and 4 part proximal humeral fracture. However compared to conservative treatment ORIF is a more desirable treatment for early function recovery and quality of life with higher total costs.

Key words: Humeral fracture, Fracture fixation, Non-operative treatment, Clinical effect

Yuneng Li, Haonan Liu, Shiwen Zhu, Yonggang Su, Yujiang Mao, Meng Zhou, Hao Wang, Xinbao Wu. Comparison of clinical result and total costs between surgical and non-operative treatment for 3 and 4 part proximal humeral fracture in the elderly[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2021, 16(05): 411-416.

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References 19

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组别	例数	平均年龄(岁，±s)	性别(例)		Neer分型(例)		患有内科疾病[例(%)]	优势侧骨折[例(%)]	Constant-murley评分(分，±s)	DASH评分(分，±s)	EQ-5D评分(分，±s)
组别	例数	平均年龄(岁，±s)	男	女	Ⅲ	Ⅳ	患有内科疾病[例(%)]	优势侧骨折[例(%)]	Constant-murley评分(分，±s)	DASH评分(分，±s)	EQ-5D评分(分，±s)
手术组	39	67.8±6.1	12	27	30	9	25(64.1)	23(59.0)	93.9±6.1	7.1±3.1	0.92±0.08
保守组	33	71.8±8.6	11	22	24	9	24(72.7)	18(54.5)	91.4±7.6	8.4±4.3	0.91±0.09
t/χ²值		1.871	0.054		0.168		0.612	0.143	0.533	0.826	0.501
P值		0.021	0.816		0.682		0.434	0.705	0.734	0.541	0.773

组别	例数	平均年龄(岁，±s)	性别(例)		Neer分型(例)		患有内科疾病[例(%)]	优势侧骨折[例(%)]	Constant-murley评分(分，±s)	DASH评分(分，±s)	EQ-5D评分(分，±s)
组别	例数	平均年龄(岁，±s)	男	女	Ⅲ	Ⅳ	患有内科疾病[例(%)]	优势侧骨折[例(%)]	Constant-murley评分(分，±s)	DASH评分(分，±s)	EQ-5D评分(分，±s)
手术组	39	67.8±6.1	12	27	30	9	25(64.1)	23(59.0)	93.9±6.1	7.1±3.1	0.92±0.08
保守组	33	71.8±8.6	11	22	24	9	24(72.7)	18(54.5)	91.4±7.6	8.4±4.3	0.91±0.09
t/χ²值		1.871	0.054		0.168		0.612	0.143	0.533	0.826	0.501
P值		0.021	0.816		0.682		0.434	0.705	0.734	0.541	0.773

组别	例数	Constant-murley评分		DASH评分		EQ-5D评分
组别	例数	术后1年	术后2年	术后1年	术后2年	术后1年	术后2年
手术组	39	76.1±10.5	78.3± 10.3	26.7±20.5	24.2± 19.3	0.78±0.21	0.79±0.19
保守组	33	68.6±11.7	69.6± 8.5	32.1±11.7.	31.1± 11.5	0.72±0.21	0.76±0.16
t值		8.772	9.031	8.331	9.309	9.033	1.201
P值		<0.001	<0.001	<0.001	<0.001	<0.001	0.102

组别	例数	Constant-murley评分		DASH评分		EQ-5D评分
组别	例数	术后1年	术后2年	术后1年	术后2年	术后1年	术后2年
手术组	39	76.1±10.5	78.3± 10.3	26.7±20.5	24.2± 19.3	0.78±0.21	0.79±0.19
保守组	33	68.6±11.7	69.6± 8.5	32.1±11.7.	31.1± 11.5	0.72±0.21	0.76±0.16
t值		8.772	9.031	8.331	9.309	9.033	1.201
P值		<0.001	<0.001	<0.001	<0.001	<0.001	0.102

组别	例数	挂号	药品/辅助器械费用	化验检查费用	康复费用	住院费用	医疗费用	非医疗费用	总体费用
手术组	39	186.4	2 472.3	678.1	174.4	4 6317.6	49 828.8	2 342.4	5 2171.2
保守组	33	303.7	1 864.5	772.4	96.8	3 976.4	7 013.8	4 094.7	1 1108.5
检验值		1.063	2.464	0.368	1.812	9.164	10.164	3.022	8.201
P值		0.224	0.031	0.682	0.034	<0.001	<0.001	<0.012	<0.001

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