Orthopaedics and Traumatology, University Hospital Leuven, Leuven, Belgium.
Injury. 2012 Feb;43(2):153-8. doi: 10.1016/j.injury.2011.04.003. Epub 2011 May 12.
Angular stable osteosynthesis has become the gold standard in the operative treatment of proximal humeral fractures. The aim of this article is to determine the indications for osteosynthesis versus primary arthroplasty based on clinical and radiological parameters.
A total of 368 surgically treated proximal humeral fractures were reviewed. Preoperative X-rays were used to evaluate the displacement and vascularity of the humeral head (according to the Hertel criteria) and the AO (Arbeitsgemeinschaft für Osteosynthesefragen) fracture type. Postoperative X-rays were analysed to assess the quality of the reduction, the reconstruction of the medial hinge and the displacement of the tuberosities. Follow-up X-rays were used to evaluate healing progress, the occurrence of avascular necrosis, loss of reduction and implant related failures. The American Shoulder and Elbow Surgeons score (ASES score) was used to evaluate the functional outcome. Correlations between a set of variables, type of treatment and eventual outcome were verified in both univariate and multivariate settings, with the significance rate set at p<0.05.
In total, 307 shoulders were evaluated. Mean follow-up was 4.3 years and showed a 15.3% failure rate, a 23.8% re-operation rate and a mean ASES score of 75.3. Better results were noted in patients who were younger at the time of surgery. More displaced fractures, AO type C fractures, varus fracture configuration and reduced head vascularity all led to a worse outcome. Anatomical reduction correlated with better results. Articular fractures had better results when treated with a plate.
Surgical treatment of proximal humeral fractures remains difficult, with a failure rate of 15.3% and a re-operation rate of 23.8% at 4.3 years. A significantly displaced varus articular fracture in the older patient results in the worst outcome.
角稳定接骨术已成为治疗肱骨近端骨折的金标准。本文旨在根据临床和影像学参数确定接骨术与初次关节置换术的适应证。
回顾分析了 368 例手术治疗的肱骨近端骨折。术前 X 线片用于评估肱骨头的移位和血供（根据 Hertel 标准）和 AO（Arbeitsgemeinschaft für Osteosynthesefragen）骨折类型。术后 X 线片分析用于评估复位质量、内侧铰链重建和结节移位。随访 X 线片用于评估愈合进展、发生缺血性坏死、复位丢失和与植入物相关的失败。美国肩肘外科医生评分（ASES 评分）用于评估功能结果。在单变量和多变量环境中，验证了一组变量、治疗类型和最终结果之间的相关性，显著性水平设置为 p<0.05。
共评估了 307 例肩关节。平均随访时间为 4.3 年，失败率为 15.3%，再次手术率为 23.8%，平均 ASES 评分为 75.3。手术时年龄较小的患者结果更好。移位更大的骨折、AO 型 C 骨折、内翻骨折形态和减少的头血供都导致了更差的结果。解剖复位与更好的结果相关。关节内骨折采用钢板治疗效果更好。
肱骨近端骨折的手术治疗仍然困难，4.3 年后失败率为 15.3%，再次手术率为 23.8%。年龄较大的患者发生明显移位的内翻关节骨折，结果最差。
