Faraj D, Kooistra B W, Vd Stappen W A H, Werre A J
Department of Surgery, Canisius Wilhelmina Hospital, P.O. Box 9015, 6500 GS Nijmegen, The Netherlands.
Eur J Orthop Surg Traumatol. 2011 Jan;21(1):7-12. doi: 10.1007/s00590-010-0655-z. Epub 2010 Jun 15.
The purpose of this study is to determine the efficacy of the open reduction and fixation of a dislocated proximal humerus fracture with a locking plate, also evaluating the incidence of complications and functional recovery of the shoulder. A retrospective study focusing on patients who had suffered a fracture of the proximal humerus and were treated by means of an open reduction and internal fixation with a locking plate, using either the Philos or the LPHP plate. We have also included a comparison of these two plates. METHOD: Ninety-two patients were found to be eligible and were included in our study. These patients had all been treated for a proximal humerus fracture between 2002 and 2008. We included those patients who could be classified as a class 2, 3, or 4 according to the Neer classification. Demographic data, surgical technique, and peri/post-operative complications were collected from medical records. Patients were followed-up and the Oxford Shoulder Score (OSS) was filled in by phone. The mean age of our patient population was 66.2 (15-97), with a male: female ratio of 1:5 (15:77). (The median follow-up was 2.4 years (0.2-5.8). Fourteen of our patients died during follow-up, while 25 patients were otherwise lost to follow-up. For this study, out of the original 131 patients, this finally resulted in 92 patients whom we followed-up post-operatively. RESULTS: Ninety-two patients (70%, 92/131) were interviewed. The mean Oxford Shoulder Score (OSS) was 19.76 (11-54). The overall complication rate was 39.1% (36/92). The most frequently occurring complications in our patient population were hemorrhage 3.3%; dislocation of the caput humeri and/or tuberculum majus 2.2%; persistent pain 3.3%; Avascular necrosis (AVN) of the humeral head 0%; Loss of reduction and screw cutout 6.5%; Plate breakout 6.5%; Subacromial Impingement 11.9%; Frozen shoulder 3.3%; rotator cuff rupture 1.1%, and infection 1.1%. Of the entire group of patients originally included in this study, 29% was re-operated due to one of the above-mentioned complications. CONCLUSION: In conclusion, the locking plate provides satisfactory functional outcomes after a mid-term follow-up in patients with displaced proximal humerus fractures. The incidence of complications and subsequent re-operation is relatively high, however, comparable to or slightly better when compared to data found in literature. Subacromial Impingement seems to occur more frequently when a Philos plate is implemented. We therefore suggest that randomized clinical trials determining the possible superiority of one specific type of plate in patients with a displaced proximal humerus fracture are to be performed in future.
本研究旨在确定使用锁定钢板切开复位固定肱骨头近端骨折的疗效，同时评估并发症的发生率及肩关节的功能恢复情况。本研究为回顾性研究，聚焦于肱骨头近端骨折且采用锁定钢板切开复位内固定治疗的患者，使用的锁定钢板为Philos或LPHP钢板。我们还对这两种钢板进行了比较。方法：92例患者符合纳入标准并纳入本研究。这些患者均在2002年至2008年期间接受了肱骨头近端骨折治疗。我们纳入了根据Neer分类可归类为2级、3级或4级的患者。从病历中收集人口统计学数据、手术技术及围手术期/术后并发症情况。对患者进行随访，并通过电话填写牛津肩关节评分（OSS）。我们患者群体的平均年龄为66.2岁（15 - 97岁），男女比例为1:5（15:77）。（中位随访时间为2.4年（0.2 - 5.8年）。14例患者在随访期间死亡，另有25例患者失访。在本研究最初的131例患者中，最终有92例患者接受了术后随访。结果：对92例患者（70%，92/131）进行了访谈。牛津肩关节评分（OSS）的平均值为19.76（11 - 54）。总体并发症发生率为39.1%（36/92）。我们患者群体中最常见的并发症为出血3.3%；肱骨头和/或大结节脱位2.2%；持续疼痛3.3%；肱骨头缺血性坏死（AVN）0%；复位丢失和螺钉穿出6.5%；钢板断裂6.5%；肩峰下撞击11.9%；肩周炎3.3%；肩袖撕裂1.1%，感染1.1%。在本研究最初纳入的所有患者中，29%因上述并发症之一接受了再次手术。结论：总之，对于肱骨头近端移位骨折患者，中期随访后锁定钢板提供了令人满意的功能结果。然而，并发症发生率及随后的再次手术率相对较高，与文献数据相比相当或略好。使用Philos钢板时肩峰下撞击似乎更常发生。因此，我们建议未来进行随机临床试验，以确定一种特定类型的钢板在肱骨头近端移位骨折患者中可能具有的优势。
