Orthopaedic and Trauma Surgery, KKH Erding, Bajuwarenstr. 5, 85435 Erding, Germany.
Clin Orthop Relat Res. 2012 Feb;470(2):602-9. doi: 10.1007/s11999-011-2056-y. Epub 2011 Aug 31.
There is a lack of consensus regarding optimal surgical management of displaced and unstable three-part proximal humeral fractures.
QUESTIONS/PURPOSES: The objective of this prospective observational study was to compare the clinical and radiologic outcomes of plate versus nail fixation of three-part proximal humeral fractures.
Two hundred eleven patients with unstable three-part proximal humeral fractures were treated with ORIF using plate (PHILOS [proximal humeral interlocking system]/LPHP [locking proximal humerus plate]) or nail (PHN [proximal humeral nail]) osteosynthesis. Outcome measurements included pain, Constant and Murley and Neer scores, and the occurrence of complications at 3, 6, and 12 months postsurgery. Regression analysis and the likelihood ratio test were used to evaluate differences between the cohorts.
Throughout the 1-year followup period the Constant and Murley scores improved significantly for both cohorts; there was no significant difference between the nail group compared with the plate group. Also, 1-year Neer scores were similar between the two cohorts. Patients in the PHN group perceived significantly less pain compared with patients in the plate fixation group at 3, 6 and 12 months after surgery. We observed 79 local complications in 60 patients with no significant risk difference between the treatment groups; 35 intraoperative complications were directly related to the initial surgical procedure.
The similar 1-year outcomes for nail versus plate fixation of three-part proximal humeral fractures suggest that both techniques may be useful for internal fixation of these fractures. Many complications were related to incorrect surgical technique and therefore can be avoided. Advanced surgical skills and experience are considered to be more critical for successful operative treatment of three-part proximal humeral fractures than the selection of the implant.
Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
对于移位和不稳定的三部分肱骨近端骨折，手术治疗的最佳方法尚未达成共识。
问题/目的：本前瞻性观察研究的目的是比较钢板与钉固定治疗三部分肱骨近端骨折的临床和影像学结果。
211 例不稳定三部分肱骨近端骨折患者采用 PHILOS（肱骨近端锁定系统）/LPHP（锁定肱骨近端板）或 PHN（肱骨近端钉）内固定治疗。术后 3、6、12 个月评估疼痛、Constant 和 Murley 评分、Neer 评分及并发症的发生情况。采用回归分析和似然比检验评估两组间的差异。
两组患者在整个 1 年随访期间的 Constant 和 Murley 评分均显著改善；两组间无显著差异。两组 1 年 Neer 评分也相似。与钢板固定组相比，PHN 组患者术后 3、6 和 12 个月时疼痛明显减轻。60 例患者中观察到 79 例局部并发症，两组间无显著风险差异；35 例术中并发症与初始手术过程直接相关。
三部分肱骨近端骨折钢板与钉固定的 1 年结果相似，提示两种技术均可用于此类骨折的内固定。许多并发症与手术技术不当有关，因此可以避免。对于三部分肱骨近端骨折的手术治疗，高级手术技能和经验被认为比植入物的选择更为关键。
II 级，治疗性研究（前瞻性比较研究）。请参阅作者指南以获取证据水平的完整描述。
