Küchle R, Hofmann A, Hessmann M, Rommens P M
Klinik und Poliklinik für Unfallchirurgie, Universitätskliniken Mainz, Langenbeckstrasse 1, 55101, Mainz, Germany.
Unfallchirurg. 2006 Dec;109(12):1017-24. doi: 10.1007/s00113-006-1159-5.
In this prospective study we evaluated the functional and radiological results obtained in 62 patients who had been treated for fracture of the humeral head by internal fixation with a cloverleaf plate. They were examined postoperatively, after 14 weeks and after an average follow-up of 75 weeks. Nine patients (14.5%) had dislocated 2-part fractures, 36 had 3-part fractures (58%; additional dislocations of the greater or lesser tubercle), 13 patients (21%) had 4-part fractures and 4 (5.6%) had luxation fractures of the humeral head. Early functional physiotherapy was started on the third day after surgery. The complications observed were: subcutaneous infection (2 cases; 3.2%), haematoma (2 cases; 3.2%), temporal paraesthesia of the axillary nerve (1 case; 1.6%). Only 4 (6.5%) patients suffered from necrosis of the humeral head (partial in 3, total in 1); in 2 cases (3.2%) we switched to a different procedure; in both these patients a humeral head prosthesis was implanted; in both these cases the clinical result was poor because of progressive varus dislocation. To improve mobility we performed arthrolysis in 8 cases (12.9%) and acromioplasty in 10 (16.1%), in addition to removing the plates after fracture consolidation confirmed by X-ray examination. In the present study those of our patients who had been treated with open reduction and internal fixation with a cloverleaf plate achieved average Neer scores of 77+/-13 and average Constant scores of 72.4+/-18, and the rates of complications or revisions were low. "Good" or "very good" results were obtained according to the Constant score in 59% of the treated patients. Even patients with complex 4-part fractures had average Constant scores of 72.7 points ("good"). The accuracy of the refixation of the greater tubercle, sufficiently low fixation of the cloverleaf plate and avoidance of varus position when the humeral head was repositioned were significant parameters influencing the functional outcome in our patients.
在这项前瞻性研究中，我们评估了62例采用三叶形钢板内固定治疗肱骨头骨折患者的功能和影像学结果。对他们进行了术后、术后14周以及平均75周随访后的检查。9例患者（14.5%）为2部分骨折脱位，36例为3部分骨折（58%；合并大结节或小结节额外脱位），13例患者（21%）为4部分骨折，4例（5.6%）为肱骨头脱位骨折。术后第三天开始早期功能理疗。观察到的并发症有：皮下感染（2例；3.2%）、血肿（2例；3.2%）、腋神经颞侧感觉异常（1例；1.6%）。仅4例（6.5%）患者出现肱骨头坏死（3例为部分坏死，1例为完全坏死）；2例（3.2%）患者我们改用了不同的手术方法；在这2例患者中均植入了肱骨头假体；在这2例中，由于进行性内翻脱位，临床结果均较差。为改善活动度，除在X线检查确认骨折愈合后取出钢板外，我们还对8例患者（12.9%）进行了关节松解术，对10例患者（16.1%）进行了肩峰成形术。在本研究中，我们采用三叶形钢板切开复位内固定治疗的患者平均Neer评分为77±13，平均Constant评分为72.4±18，并发症或翻修率较低。根据Constant评分，59%的治疗患者获得了“良好”或“非常好”的结果。即使是复杂的4部分骨折患者，平均Constant评分也达到了72.7分（“良好”）。大结节重新固定的准确性、三叶形钢板固定不够牢固以及肱骨头复位时避免内翻位是影响我们患者功能结果的重要参数。
