Clinical Trauma Fellow, Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, UK.
J Shoulder Elbow Surg. 2009 Nov-Dec;18(6):837-44. doi: 10.1016/j.jse.2009.06.004. Epub 2009 Sep 12.
Locking plates with special configuration for the anatomic region of the proximal humerus have been introduced recently to address the difficulties of stabilizing proximal humeral fractures. The purpose of this study was to carry out a systematic review of the literature on the efficacy and early to medium term functional results of locking plates for stabilization of proximal humeral fractures.
Using the PubMed database, a systematic review of the English and German literature was carried out in order to assess the efficacy and complications related to the use of these plates and the patients' functional outcome, using the key words "locking plates proximal humeral fractures," "angular stability plates proximal humeral fractures," "PHILOS plate," and "LPHP plate." Our criteria for eligibility were clinical studies with more than ten cases followed-up, adult patients, and adequate data provided at least in terms of implant related complications. Articles written in English and German language were included. Exclusion criteria were: studies dealing exclusively with 2-part fractures (since this category has a more favorable outcome); experimental studies; case reports; and, literature other than English or German. Each one of the articles was evaluated for quality of the study using the Structured Effectiveness Quality Evaluation Scale (SEQES).
Twelve studies including 791 patients met the inclusion criteria. Patients in these studies continued to improve up to one year, achieving a mean Constant score of 74.3. The incidence of the reported complications was: avascular necrosis 7.9%, screw cut-out 11.6% and re-operation rate 13.7%.
The high incidence of cut-out may be secondary to the rigidity of the implant in combination with medial inadequate support, in cases compromised by severe underlying osteoporotic bone. Definition of indications for the use of locking plates and attention on technical aspects of applying them would help optimization of the results.
Systematic Review.
为了应对稳定肱骨近端骨折的困难，最近引入了具有解剖区域特殊配置的锁定板。本研究的目的是对锁定板治疗肱骨近端骨折的疗效和早期至中期功能结果进行系统评价。
使用 PubMed 数据库，对英语和德语文献进行系统评价，以评估这些钢板的使用效果和并发症以及患者的功能结果，使用的关键词为“锁定钢板肱骨近端骨折”、“角稳定钢板肱骨近端骨折”、“PHILOS 钢板”和“LPHP 钢板”。我们的纳入标准为：随访超过 10 例的临床研究、成年患者和至少在植入物相关并发症方面提供足够数据的研究。纳入英语和德语文献。排除标准为：仅涉及 2 部分骨折的研究（因为这类骨折的预后更好）；实验研究；病例报告；以及非英语或德语的文献。使用结构化有效性质量评估量表（SEQES）对每一篇文章进行研究质量评估。
符合纳入标准的研究共有 12 项，包括 791 例患者。这些研究中的患者在一年持续改善，平均 Constant 评分为 74.3。报告的并发症发生率为：缺血性坏死 7.9%、螺钉脱出 11.6%和再次手术率 13.7%。
高脱出率可能与植入物的刚性结合内侧支撑不足有关，在严重的潜在骨质疏松性骨的情况下更为明显。锁定板使用适应证的定义和对应用技术方面的关注将有助于优化结果。
系统评价。
