Division of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
J Orthop Surg Res. 2011 Sep 24;6:50. doi: 10.1186/1749-799X-6-50.
With new minimally-invasive approaches for angular stable plate fixation of proximal humeral fractures, the need for the placement of oblique inferomedial screws ('calcar screw') has increasingly been discussed. The purpose of this study was to investigate the influence of calcar screws on secondary loss of reduction and on the occurrence of complications.
Patients with a proximal humeral fracture who underwent angular stable plate fixation between 01/2007 and 07/2009 were included. On AP views of the shoulder, the difference in height between humeral head and the proximal end of the plate were determined postoperatively and at follow-up. Additionally, the occurrence of complications was documented. Patients with calcar screws were assigned to group C+, patients without to group C-.
Follow-up was possible in 60 patients (C+ 6.7 ± 5.6 M/C- 5.0 ± 2.8 M). Humeral head necrosis occurred in 6 (C+, 15.4%) and 3 (C-, 14.3%) cases. Cut-out of the proximal screws was observed in 3 (C+, 7.7%) and 1 (C-, 4.8%) cases. In each group, 1 patient showed delayed union. Implant failure or lesions of the axillary nerve were not observed. In 44 patients, true AP and Neer views were available to measure the head-plate distance. There was a significant loss of reduction in group C- (2.56 ± 2.65 mm) compared to C+ (0.77 ± 1.44 mm; p = 0.01).
The placement of calcar screws in the angular stable plate fixation of proximal humeral fractures is associated with less secondary loss of reduction by providing inferomedial support. An increased risk for complications could not be shown.
随着微创入路用于治疗肱骨近端骨折的角稳定钢板固定术的出现，对于斜向内侧的髓内螺钉（“骺板螺钉”）放置的必要性越来越受到关注。本研究的目的是探讨骺板螺钉对内固定术后复位丢失的影响及其并发症的发生情况。
纳入 2007 年 1 月至 2009 年 7 月期间接受角稳定钢板固定术治疗肱骨近端骨折的患者。术后和随访时，在肩关节正位 X 线片上测量肱骨头和钢板近端之间的高度差异。同时记录并发症的发生情况。有骺板螺钉的患者分为 C+组，无骺板螺钉的患者分为 C-组。
60 例患者（C+组 6.7 ± 5.6 M/C-组 5.0 ± 2.8 M）获得随访。C+组有 6 例（15.4%）和 C-组有 3 例（14.3%）发生肱骨头坏死。C+组有 3 例（7.7%）和 C-组有 1 例（4.8%）发生近端螺钉切出。每组各有 1 例患者发生延迟愈合。未观察到内固定物失败或腋神经损伤。在 44 例患者中，可获得正位和 Neer 位 X 线片来测量头-板距离。C-组的复位丢失明显多于 C+组（2.56 ± 2.65 mm 比 0.77 ± 1.44 mm；p = 0.01）。
在肱骨近端骨折的角稳定钢板固定术中，骺板螺钉的置入可提供内侧支撑，从而减少继发性复位丢失。但也未能显示并发症风险增加。
