对四部分肱骨近端骨折的老年患者采取半髋关节置换术与非手术治疗的比较：一项随机对照试验

"Background: The aim of the study was to report the 2-year outcome after a displaced 4-part fracture of the proximal humerus in elderly patients randomized to treatment with a hemiarthroplasty (HA) or nonoperative treatment.
Patients and Methods:
We included 55 patients, mean age 77 (range, 58-92) years, 86% being women. Follow-up examinations were done at 4, 12, and 24months. The main outcome measures were health-related quality of life (HRQoL) according to the EQ-5D and the DASH and Constant scores.
Results:
At the final 2-year follow-up the HRQoL was significantly better in the HA group compared to the nonoperative group, EQ-5Dindex score 0.81 compared to 0.65 (P=.02). The results for DASH and pain assessment were both in favor of the HA group, DASH score 30 versus 37 (P=.25) and pain according to VAS 15 versus 25 (P=.17). There were no significant differences regarding the Constant score or range of motion (ROM). Both groups achieved a mean flexion of approximately 90-95° and a mean abduction of 85-90°. The need for additional surgery was low: 3 patients in the HA group and 1 patient in the nonoperative group.
Conclusion:
The results of the study demonstrated a significant advantage in quality of life in favor of HA, as compared to nonoperative treatment in elderly patients with a displaced 4-part fracture of the proximal humerus. The main advantage of HA appeared to be less pain while there were no differences in ROM."