Linhart Wolfgang, Ueblacker Peter, Grossterlinden Lars, Kschowak Philipp, Briem Daniel, Janssen Arne, Hassunizadeh Behrus, Schinke Marte, Windolf Joachim, Rueger Johannes Maria
Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Orthop Trauma. 2007 May;21(5):285-94. doi: 10.1097/BOT.0b013e318059b5a1.
OBJECTIVES/DESIGN: To assess the functional outcome after treatment of proximal humeral fractures with a new antegrade nail that provides angular and sliding stability. INTERVENTION/PATIENTS: Ninety-seven patients were treated during a 4-year period between April 2000 and March 2004. All patients were followed for 6 months, 51 patients (53%) for 12 months, and 31 patients (32%) for 24 months. This study focuses mainly on the patients with a follow up of 1 year. Their mean age was 68 years (range: 33 to 90); 22% were more than 80 years of age.
All fractures were radiologically graded by the Neer and AO/ASIF classifications. Clinical assessment was performed at all follow-up visits using the Constant-Murley and Neer scores, and complications were recorded.
There were 26.8% 2-part, 66% 3-part, and 7.2% 4-part fractures. The relative Constant-Murley score improved significantly (P < 0.001) from 72% at 6 months to 82% at 12 months after operation. No further improvement regarding functional outcome was observed after 24 months. Patients younger than 60 years of age had better results. No significant functional differences were found among 2-, 3- or 4-part fractures. Complications included backing out of the proximal screws (9.8%), secondary dislocation (1.9%), complete osteonecrosis (1.9%), and partial osteonecrosis (5.8%).
Treatment with this nail provides sufficient fixation of the fragments to allow early mobilization. The good functional results in the majority of the patients indicate that this nail can be used, even in complex fractures and elderly patients.
目的/设计：使用一种能提供角度和滑动稳定性的新型顺行髓内钉评估肱骨近端骨折治疗后的功能结果。干预措施/患者：在2000年4月至2004年3月的4年期间，对97例患者进行了治疗。所有患者均随访6个月，51例患者（53%）随访12个月，31例患者（32%）随访24个月。本研究主要关注随访1年的患者。他们的平均年龄为68岁（范围：33至90岁）；22%的患者年龄超过80岁。
所有骨折均根据Neer和AO/ASIF分类进行放射学分级。在所有随访时使用Constant-Murley和Neer评分进行临床评估，并记录并发症。
2部分骨折占26.8%，3部分骨折占66%，4部分骨折占7.2%。相对Constant-Murley评分从术后6个月时的72%显著提高（P < 0.001）至12个月时的82%。24个月后未观察到功能结果有进一步改善。年龄小于60岁的患者结果更好。2部分、3部分或4部分骨折之间未发现显著的功能差异。并发症包括近端螺钉退出（9.8%）、继发性脱位（1.9%）、完全性骨坏死（1.9%）和部分性骨坏死（5.8%）。
使用这种髓内钉治疗能为骨折碎片提供足够的固定，以便早期活动。大多数患者良好的功能结果表明，即使是复杂骨折和老年患者也可使用这种髓内钉。
