Trauma Division, Department of Surgery, Stadtspital Triemli, Zurich, Switzerland.
J Trauma Acute Care Surg. 2012 Mar;72(3):783-92. doi: 10.1097/TA.0b013e31822c1b5b.
Since 2003, we have used the Proximal Humerus Interlocking System plate for treatment of proximal humeral fractures. Although many patients have good and excellent results, the reported rate of complications varies. We have focused on the complication rate and risk factors for complications 1 year after surgery.
From 2003 until 2008, a total of 294 (223 women; 71 men; median age, 72.9) patients were included. General data were collected at the time of injury (Charlson Index, smoking, and steroid therapy). Fractures were classified (AO/OTA) retrospectively. The follow-up of 1 year included radiographs and Constant-Murley score for functionality. Complications and revision surgeries were analyzed specifically.
We found 83 (28.2%) patients with a total of 105 complications, requiring a total of 72 (24.5%) revision surgeries. The most frequent complication was screw cutout (33 of 294, 11.2%), because of secondary fracture displacement or avascular necrosis (AVN). AVN (20 of 294, 6.8%) was the main reason for secondary arthroplasty. Smoking more than 20 pack years had a significant impact on the complication rate. Fractures classified 11-A3 showed more implant failures. Fracture dislocations predisposed to secondary screw cutout and AVN. Patients without complications (211, 71.8%) achieved a median Constant-Murley score of 89 (40-100) points.
This study points out several predisposing factors for negative outcome after open reduction and internal fixation with the Proximal Humerus Interlocking System plate (fracture type: 11-A3, fracture dislocations, and smoking). Accounting for these, patient's risk for complications can be evaluated more individually and taken into consideration for the concept of treatment. Altering the surgical technique was associated with a significant reduction in the incidence of secondary screw cutout.
自 2003 年以来，我们一直使用肱骨近端锁定系统钢板治疗肱骨近端骨折。尽管许多患者取得了良好和优秀的结果，但报告的并发症发生率有所不同。我们关注的是手术后 1 年的并发症发生率和并发症的危险因素。
2003 年至 2008 年，共纳入 294 例患者（女 223 例，男 71 例；中位年龄 72.9 岁）。受伤时收集一般资料（Charlson 指数、吸烟和皮质类固醇治疗）。骨折采用（AO/OTA）回顾性分类。1 年的随访包括影像学和Constant-Murley 评分以评估功能。具体分析并发症和翻修手术。
我们发现 83 例（28.2%）患者共发生 105 例并发症，共行 72 例（24.5%）翻修手术。最常见的并发症是螺钉切出（294 例中有 33 例，11.2%），原因是继发性骨折移位或缺血性坏死（AVN）。AVN（294 例中有 20 例，6.8%）是继发性关节置换的主要原因。吸烟超过 20 包年对并发症发生率有显著影响。11-A3 型骨折显示更多的植入物失败。骨折脱位易发生继发性螺钉切出和 AVN。无并发症患者（211 例，71.8%）Constant-Murley 评分中位数为 89 分（40-100 分）。
本研究指出肱骨近端锁定系统钢板切开复位内固定术后不良结局的几个危险因素（骨折类型：11-A3、骨折脱位和吸烟）。考虑到这些因素，可以更个体化地评估患者的并发症风险，并将其纳入治疗概念。改变手术技术与继发性螺钉切出发生率显著降低有关。
