Voigt C, Woltmann A, Partenheimer A, Lill H
Klinik für Unfall- und Wiederherstellungschirurgie, Friederikenstift Hannover mit Unfallklinik, Humboldtstrasse 5, 30169 Hannover, Germany.
Chirurg. 2007 Jan;78(1):40-6. doi: 10.1007/s00104-006-1241-0.
In this prospective study, complications observed after angularly stable proximal humerus plate fixation (locking proximal humerus plate) were analysed by deriving specific therapies.
Fifty patients (median age 65 years, range 25-84 years, 39 female, 11 male) with displaced proximal humerus fractures (seven single, 36 double, and seven triple fractures) were evaluated 3, 6, and 12 months after angularly stable plate fixation using a standard protocol.
Age- and gender-matched median constant scores 12 months postoperatively showed for the three fracture types 86, 87, and 55 points and complication rates of 14, 19, and 100%, respectively. There were seven primary and seven secondary implant displacements, five humeral head necroses, four osseous malalignments, two nonunions, two deep infections, and one heterotopic ossification. Nine reoperations were required in six patients: implant removal (n=3), reosteosynthesis (n=2), revision because of nonunion (n=2), and deep infection (n=2).
Differentiated analysis of complications and the development of specific prevention and therapeutic strategies considering surgical technique, implant, fracture morphology, and humeral head perfusion minimize the rate of complications observed after angularly stable locking proximal humerus plate fixation.
在这项前瞻性研究中，通过制定特定治疗方法，分析了肱骨近端角稳定钢板固定术（锁定肱骨近端钢板）后观察到的并发症。
五十例肱骨近端移位骨折患者（年龄中位数65岁，范围25 - 84岁，女性39例，男性11例）（七例单骨折、36例双骨折和七例三部分骨折），在角稳定钢板固定术后3、6和12个月，采用标准方案进行评估。
术后12个月，年龄和性别匹配的Constant评分中位数显示，三种骨折类型分别为86分、87分和55分，并发症发生率分别为14%、19%和100%。有七例初次和七例二次植入物移位、五例肱骨头坏死、四例骨畸形愈合、两例骨不连、两例深部感染和一例异位骨化。六名患者需要进行九次再次手术：取出植入物（n = 3）、再次骨合成（n = 2）、因骨不连翻修（n = 2）和深部感染翻修（n = 2）。
对并发症进行差异化分析，并根据手术技术、植入物、骨折形态和肱骨头血运情况制定特定的预防和治疗策略，可降低肱骨近端角稳定锁定钢板固定术后观察到的并发症发生率。
