Handschin Alexander E, Cardell Markus, Contaldo Claudio, Trentz Otmar, Wanner Guido A
Division of Trauma Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Injury. 2008 Mar;39(3):306-13. doi: 10.1016/j.injury.2007.10.011.
The availability of angular-stable plate/screw systems led to a euphoric use of these implants for the treatment of displaced proximal humerus fractures. The high implant costs seem to be justified by a potentially improved outcome.
Thirty one patients (20 female, 11 male, mean age: 62+/-16 years) with two-, three- and four-part proximal humerus fractures (Neer classification) were operated using the proximal humeral internal locking system (PHILOS). The mean follow-up time was 19+/-3 postoperative months (range: 340-720 days). Functional results (Constant score, UCLA-score) were analysed and compared to an equivalent historic control group of 60 patients operated for the same fracture types using two one-third tubular plates. Additionally, total implant costs for each technique were compared.
Complications in the PHILOS group included one implant failure with refracture, one secondary dislocation, two cases of subacromial impingement, and two cases of partial avascular necrosis of the humeral head. The mean Constant score (age- and sex-matched) was 80+/-11% for the affected side and 104+/-13% for the healthy side. The UCLA scores were excellent in 10%, good in 67%, and fair in 23% of the patients. Complication rate and functional results did not differ significantly from the control group treated with one-third tubular plates. Implant costs were significantly higher for the PHILOS group (684+/-40 Euro vs. 158+/-20 Euro, p<0.05).
Our study showed similar functional results using either plate. Although the PHILOS plate may provide important advantages in specific situations, such as osteoporotic bone, its use as a standard must be carefully judged under the economic aspect of the significant higher implant costs.
角稳定钢板/螺钉系统的出现使得这些植入物被大量用于治疗肱骨近端移位骨折。高昂的植入物成本似乎因潜在的更好疗效而变得合理。
31例（20例女性，11例男性，平均年龄：62±16岁）肱骨近端二、三、四部分骨折（Neer分类）患者采用肱骨近端锁定接骨板系统（PHILOS）进行手术。平均随访时间为术后19±3个月（范围：340 - 720天）。分析功能结果（Constant评分、UCLA评分），并与使用两块三分之一管状钢板治疗相同骨折类型的60例历史对照患者进行比较。此外，还比较了每种技术的总植入物成本。
PHILOS组的并发症包括1例植入物失败伴再骨折、1例继发性脱位、2例肩峰下撞击以及2例肱骨头部分缺血性坏死。患侧平均Constant评分（年龄和性别匹配）为80±11%，健侧为104±13%。UCLA评分中，10%的患者为优秀，67%为良好，23%为一般。并发症发生率和功能结果与使用三分之一管状钢板治疗的对照组相比无显著差异。PHILOS组的植入物成本显著更高（684±40欧元对158±20欧元，p<0.05）。
我们的研究表明，使用两种钢板的功能结果相似。尽管PHILOS钢板在特定情况下可能具有重要优势，如骨质疏松性骨，但鉴于其显著更高的植入物成本，在经济方面必须谨慎判断是否将其作为标准治疗方法。
