0 Introduction (20.9%) [7]

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1 Chinese Journal of Tissue Engineering Research ( ) DOI: /j.issn ORCID: () :R318 :A () 3 (P < 0.05)Constant Constant (P < 0.05) Effects of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for the treatment of nonunions of proximal humeral fractures in the elderly Luo Deng-ke, Chen Ken, Qin Ping, Zhou Na-xin, Yu Ji-zhe, Zou Ji, Chen He-qiang, Xiao Qi-san (First College of Clinical Medical Science, China Three Gorges University; Second Department of Orthopedics, Yichang Central People s Hospital, Yichang , Hubei Province, China) Abstract BACKGROUND: Proximal humeral fracture is a common disease of fall injury in the elderly, because of bone nonunion after treatment with a variety of factors such as senile osteoporosis. Currently, the use of reverse total shoulder arthroplasty has achieved good clinical effect, but has certain limitations. OBJECTIVE: To compare and observe the clinical effects of reverse total shoulder arthroplasty and open reduction and internal plate fixation in the treatment of nonunion of proximal humeral fractures. METHODS: Totally 120 cases of nonunion of proximal humeral fractures were randomly divided into Luo Deng-ke, Master, Attending physician, First College of Clinical Medical Science, China Three Gorges University; Second Department of Orthopedics, Yichang Central People s Hospital, Yichang , Hubei Province, China Corresponding author: Zhou Na-xin, Chief physician, First College of Clinical Medical Science, China Three Gorges University; Second Department of Orthopedics, Yichang Central People s Hospital, Yichang , Hubei Province, China : (2018)

2 . [J] (15): DOI: /j.issn observation group and control group, with 60 cases in each group. The observation group received reverse total shoulder arthroplasty (replacement of artificial shoulder joint). The control group received open reduction and internal plate fixation. RESULTS AND CONCLUSION: (1) Follow-up results: At 3 years after surgery, the pain score was lower in the observation group than that in the control group (P < 0.05). Constant daily activities, range of activities, strength test score, Constant total score, satisfaction and hospitalization expenses were higher in the observation group than in the control group. Functions of flexion, laterotorsion and intorsion were better in the observation group than those in the control group (P < 0.05). (2) Adverse reactions: At 3 years after surgery, 26 and 22 cases had adverse reaction in the observation group and the control group respectively. (3) The results show that the clinical effect of the elders nonunion of proximal humeral fracture treated with reverse total shoulder arthroplasty is quite good, and the pain degree and shoulder function are obviously improved. The curative effect of reverse total shoulder arthroplasty is better than that of open reduction and internal plate fixation. Subject headings: Tissue Engineering; Shoulder Joint; Humerus 0 Introduction [1] [2] [3] [4] [5-6] (20.9%) [7] [8-9] 1Subjects and methods X EXCEL(RAND)132 2(FIXED) (15.0±3.4) (14.0±2.9) XCT 2 (KY ) 1.4 () (/ 36 mm)7 3 mm(/ 36 mm)(/8 mm 130 mm) /(/ mm) (3.53() )HC( HCZ ) ISSN CN /R CODEN: ZLKHAH

3 Luo DK, Chen K, Qin P, Zhou NX, Yu JZ, Zou J, Chen HQ, Xiao QS. Effects of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for the treatment of nonunions of proximal humeral fractures in the elderly. Zhongguo Zuzhi Gongcheng Yanjiu. 2018;22(15): DOI: /j.issn CX3 48 h Constant [10] Constant 35/ XCT [11-13] 2 90 [14] =(+)/ 100% [15] SPSS 17.0 x _ ±s t 2 [16-17] P < Results (P > 0.05) Figure 1 Flow chart of the trial 1 Table 1 Comparison of baseline data in both groups (n) () (n) (n) (P > 0.05) 2.3 2Constant (P > 0.05)3 (P < 0.05) (P > 0.05)32 (P < 0.05) (P > 0.05) (20) P.O. Box 10002, Shenyang

4 . [J] (15): DOI: /j.issn ( 3 )Constant Table 2 Comparison of Constant total score and item score before and 3 years after surgery in both groups (x _ ±sn=57) 5.3± ± ± ± ± ±2.2 ab 15.9±2.5 ab 38.8±0.4 ab 24.7±0.4 ab 87.4±9.6 ab 4.9± ± ± ± ± ±2.1 a 11.92±4.3 a 33.1±1.9 a 19. 6±1.7 a 75.6±10.2 a a P < 0.05 b P < ( 3 ) (x _ ±sn=57 ) Table 3 Comparison of shoulder function before and 3 years after surgery in both groups 42.9± ± ± ±4.3 ab 35.5±2.5 ab 59.7±3.4 ab 40.8± ± ± ±3.3 a 30.8±1.8 a 40.1±1.9 a a P < 0.05 b P < Table 4 Occurrence of adverse reactions in both groups (n=57) (n=57) 20(35.1) 3(5.3) 13(22.8) 0 3(5.3) 7(12.3) 3(5.3) 7(12.3) 0 9(15.8) 0 4(7.0) 0 7(12.3) [n(%)] 5 3 (n=57) Table 5 Comparison of satisfaction 3 years after surgery in both groups [n(%)] [n(%)] [n(%)] (%) 15(25.0) a 20(33.3) 25(41.7) a 58.3 a 6(10.0) 20(33.3) 34(56.7) 43.3 a P < % 43.3%(P < 0.05)5 2.8 ( ± 681.4)( ±317.4) (P < 0.01) 3Discussion 3.1 4%5% 2 [18-19] [20] [21] [22] [23] (P < 0.05) [24] [25] Zumstein [26] 97.3% mm44 mm Martinez [27] 42 mm 2330 ISSN CN /R CODEN: ZLKHAH

5 Luo DK, Chen K, Qin P, Zhou NX, Yu JZ, Zou J, Chen HQ, Xiao QS. Effects of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for the treatment of nonunions of proximal humeral fractures in the elderly. Zhongguo Zuzhi Gongcheng Yanjiu. 2018;22(15): DOI: /j.issn ( ) Figure 2 Intraoperative resection of nodules in typical case 1 in the observation group X A X B X 3 3 2() Figure 3 Intraoperative retention of nodules in the typical case 2 of the observation group A X B X () 4 C X 4 4 3() Figure 4 Typical case 3 in the control group A 3 B C [28] [29] Clouthier [30] 4(6.7%) Trappey [31] [32] 2 [33] [34] 3.3 [35] [36-37] 57Constant P.O. Box 10002, Shenyang

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