Department of Orthopaedic and Trauma Surgery, Albert-Ludwigs-University Freiburg, Hugstetter Strasse 55, Freiburg, Germany.
J Bone Joint Surg Am. 2010 Mar;92 Suppl 1 Pt 1:85-95. doi: 10.2106/JBJS.I.01462.
The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate.
One hundred and eighty-seven patients (mean age, 62.9 +/- 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six month,and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up.
Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 +/- 13.7 points, corresponding to 85.1% +/- 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 +/- 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture.
Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the present study can lead to a good functional outcome provided that the correct surgical technique is used. Because many of the complications were related to incorrect surgical technique, it behooves the treating surgeon to perform the operation correctly to avoid iatrogenic errors.
不稳定移位的肱骨近端骨折的治疗，尤其是老年人，仍然存在争议。本前瞻性、多中心、观察性研究的目的是评估使用锁定肱骨近端板对肱骨近端骨折进行切开复位内固定的功能结果和并发症发生率。
187 例（平均年龄 62.9±15.7 岁）急性肱骨近端骨折患者采用切开复位内固定锁定肱骨近端板治疗。在术后 3 个月、6 个月和 1 年随访时，165 例（88%）、158 例（84%）和 155 例（83%）患者评估疼痛、肩部活动度和力量。在每个时间点评估Constant 评分，在 1 年随访时评估损伤侧和对侧上肢的残疾程度、上肢、肩部和手（DASH）评分。
术后 3 个月至 1 年，患侧的平均运动范围和 Constant 评分明显改善。术后 12 个月，患侧的平均 Constant 评分为 70.6±13.7 分，相当于对侧的 85.1%±14.0%。1 年随访时，平均 DASH 评分为 15.2±16.8 分。52 例（34%）155 例患者在 1 年随访时发生 62 例并发症。25 例（40%）与手术技术不正确有关，在手术结束时出现。最常见的并发症，21 例（14%）患者术中螺钉穿透肱骨头，29 例（19%）患者在骨折后 12 个月内进行了计划外二次手术。
本研究评估的使用锁定肱骨近端板治疗移位的肱骨近端骨折可以获得良好的功能结果，前提是正确使用手术技术。由于许多并发症与手术技术不正确有关，因此，治疗医生有必要正确操作，避免医源性错误。
