Department of Orthopaedic Surgery, Wrightington Hospital, UK.
Injury. 2010 Jun;41(6):572-7. doi: 10.1016/j.injury.2009.09.023. Epub 2009 Oct 24.
The aim of this study is to examine the demographic factors, functional outcome and radiological data to predict the outcome of humeral diaphyseal fractures.
We performed a prospective study on a consecutive series of 110 patients of 16 years or over, who had sustained a humeral diaphyseal fracture. There were 42 males and 68 females, with an average age of 59 years (range 16-93 years). A total of 72% sustained low-energy injuries, and 89 patients (81%) were primarily treated non-operatively. Shoulder function was assessed using the Neer's and Constant's scores at 8 weeks, 3 months, 6 months and 1 year after injury. Muscle strength was determined isokinetically using a Biodex System 2 dynamometer. Non-union was defined as a failure to bridge at least three cortices and persistence of tenderness or mobility at the fracture site 16 weeks after fracture.
Sixteen patients (17%) had non-union at 16 weeks, while 80 had achieved union and a further 14 were lost to follow-up. After stepwise multiple linear regression was performed to isolate independent factors affecting outcome, only the presence of a proximal diaphyseal fracture was found to predict non-union along with a poor Neer's score at 8 and 12 weeks. Poor Neer's scores could be predicted at 26 weeks by age (P<0.05), previous stroke (P<0.001) and non-union (P<0.001). At 52 weeks both age (P<0.01) and previous stroke (P<0.01) were independently predictive of poorer Neer's scores. Malunion of any degree had no detectable effect on function.
Our results indicate that non-union of humeral diaphyseal fractures can be predicted in the presence of a proximal third fracture with a Neer's score of less than 45 by 12 weeks after fracture. Early surgery improves early function, but this is not a lasting effect. Poor shoulder function is predicted by increasing age, proximal third fractures and non-union. We recommend that surgery to promote union be considered at 12 weeks after fracture in fit patients with fractures of the proximal third of the humerus, poor Neer's scores and no radiographic progression to union.
本研究旨在探讨人口统计学因素、功能结果和影像学数据，以预测肱骨干骨折的预后。
我们对 110 例年龄在 16 岁及以上的肱骨干骨折患者进行了连续系列前瞻性研究。男性 42 例，女性 68 例，平均年龄 59 岁（16-93 岁）。共有 72%的患者为低能量损伤，89 例（81%）患者主要接受非手术治疗。受伤后 8 周、3 个月、6 个月和 1 年采用 Neer 和 Constant 评分评估肩部功能。使用 Biodex System 2 测力计等速测力确定肌肉力量。骨折后 16 周未愈合定义为至少有 3 个皮质未桥接，骨折部位仍有压痛或活动。
16 周时，16 例（17%）患者发生骨折不愈合，80 例患者骨折愈合，14 例患者失访。逐步多元线性回归分析显示，只有近端骨干骨折和 8 周及 12 周 Neer 评分较差与骨折不愈合相关。26 周时，年龄（P<0.05）、既往卒中（P<0.001）和骨折不愈合（P<0.001）可预测 Neer 评分较差。52 周时，年龄（P<0.01）和既往卒中（P<0.01）是 Neer 评分较差的独立预测因素。任何程度的愈合不良对功能均无明显影响。
我们的结果表明，在骨折后 12 周时，Neer 评分<45 分的近端三分之一骨折可预测肱骨干骨折不愈合。早期手术可改善早期功能，但无持久效果。年龄增加、近端三分之一骨折和骨折不愈合可预测肩部功能不良。我们建议在骨折后 12 周时，对近端三分之一肱骨骨折、Neer 评分较差且无愈合进展的合适患者，考虑手术促进愈合。
