Department of Surgery, Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
Injury. 2012 Oct;43(10):1651-6. doi: 10.1016/j.injury.2012.04.015. Epub 2012 May 12.
In the treatment of proximal humeral fractures, the decision between open fixation and arthroplasty is often difficult. Applicable radiographic prognostic factors would be useful. The purpose of the present study was to investigate the influence of calcar comminution on the clinical and radiologic outcome after locking plate fixation of these fractures.
In patients with proximal humeral fractures that were treated by locking plate fixation, fracture morphology and the presence of comminution of the calcar were documented on preoperative radiographs. Follow-up for at least 2 years with radiologic assessment and functional outcome measurements including Constant score, subjective shoulder value (SSV), disabilities of the arm, shoulder and hand score (DASH), visual analogue scale (VAS) and short form (SF)-36 was performed.
Follow-up examination (50.8±20.6 months) was possible in 74 patients (46 female, 28 male, age 63.0±15.9 years). Mean absolute Constant score (CS abs), CS adapted to age and gender (CS adap), DASH, SSV and VAS were 72.4±14.5, 85.2±17.3%, 15.7±17.3, 80.3±19.6% and 2.1±2.2. Nonunion was present in 1.3%, cut-out in 5.4% and implant failure in 1.3%. Avascular necrosis (AVN) was seen in 12.2%, in three cases >24 months after the initial trauma. In the presence of calcar comminution, the clinical outcome (CS abs, CS adap, SSV and several parameters of SF-36) was significantly impaired, the odds ratio for these patients to have an absolute CS<65 was 4.4 (95% confidence interval (CI): 1.4-13.7).
The treatment of proximal humeral fractures with locking plate fixation achieves good clinical mid-term results. Calcar comminution is a relevant and easy-to-detect prognostic factor for the functional and subjective outcome in these fractures.
在治疗肱骨近端骨折时，往往难以在切开固定与关节置换之间做出决策。适用的影像学预后因素将非常有用。本研究的目的是探讨锁定钢板固定治疗这些骨折时，肱骨头解剖颈粉碎对临床和影像学结果的影响。
对接受锁定钢板固定治疗的肱骨近端骨折患者，记录术前 X 线片上的骨折形态和肱骨头解剖颈粉碎情况。至少 2 年的随访，包括影像学评估和功能结果测量，包括 Constant 评分、主观肩部值（SSV）、手臂、肩部和手残疾评分（DASH）、视觉模拟评分（VAS）和简化 36 健康调查（SF-36）。
74 例患者（46 例女性，28 例男性，年龄 63.0±15.9 岁）接受了随访检查（50.8±20.6 个月）。平均绝对 Constant 评分（CS abs）、年龄和性别校正的 Constant 评分（CS adap）、DASH、SSV 和 VAS 分别为 72.4±14.5、85.2±17.3%、15.7±17.3、80.3±19.6%和 2.1±2.2。骨折不愈合 1.3%，钢板螺钉切出 5.4%，内固定失败 1.3%。骨坏死（AVN）12.2%，3 例在初次创伤后 24 个月以上出现。存在肱骨头解剖颈粉碎时，临床结果（CS abs、CS adap、SSV 和 SF-36 的几个参数）明显受损，这些患者绝对 CS<65 的优势比为 4.4（95%置信区间（CI）：1.4-13.7）。
锁定钢板固定治疗肱骨近端骨折可获得良好的中期临床结果。肱骨头解剖颈粉碎是这些骨折功能和主观结果的一个相关且易于检测的预后因素。
