Piątkowski Krzysztof, Kwiatkowski Krzysztof, Piekarczyk Piotr, Przybycień Mateusz, Zaborowski Damian
Pol Orthop Traumatol. 2013 Nov 15;78:239-46.
Therapeutic management of proximal humerus fractures is still controversial. There are several ways of proceeding in these cases, ranging from conservative treatment to shoulder joint arthroplasty. Open surgical reduction and stabilization with a locking compression plate is currently the most widely used method of treatment, especially in younger patients. The purpose of this study is to analyze the results of surgical treatment of fractures of the proximal humerus using locking compression plates.
The study included 69 patients, 57 of them reported for the follow-up (82.6% of respondents). Clinical and radiological evaluation was performed at 6 weeks and 6 months following the surgery. Functional outcome was assessed using the Constant score. We also evaluated shoulder flexion active range of motion. Bone union and common complications were evaluated on the basis of radiographs--humeral head necrosis and the evidence of loosening of the bone-binding material.
The mean Constant score was 68.9 points and 75.94% relative to the opposite limb (relative mean score). No bone healing was observed in 7% (4 of 57) patients. There was a total of 21% (12 of 57) cases of humeral head necrosis. These changes varied in nature, location and severity. In 2 cases, reoperation was required due to loosening of the bone-binding material. Shoulder flexion active range of motion averaged 132 degrees and was lower in cases of 4-part fractures.
Surgical treatment of stable 3-part fractures of the proximal humerus using locking compression plate should be the treatment of choice in younger patients. Given the poor results, the choice of treatment involving 4-part fractures should be individually tailored.
肱骨近端骨折的治疗管理仍存在争议。处理这些病例有多种方法，从保守治疗到肩关节置换术。使用锁定加压钢板进行切开复位内固定目前是最广泛应用的治疗方法，尤其是在年轻患者中。本研究的目的是分析使用锁定加压钢板治疗肱骨近端骨折的手术效果。
该研究纳入69例患者，其中57例进行了随访（应答率82.6%）。在术后6周和6个月进行临床和影像学评估。使用Constant评分评估功能结果。我们还评估了肩关节主动屈曲活动范围。根据X线片评估骨愈合情况及常见并发症——肱骨头坏死和骨固定材料松动迹象。
平均Constant评分为68.9分，相对于对侧肢体的相对平均评分为75.94%。7%（57例中的4例）患者未观察到骨愈合。共有21%（57例中的12例）发生肱骨头坏死。这些改变在性质、位置和严重程度上各不相同。2例因骨固定材料松动需要再次手术。肩关节主动屈曲活动范围平均为132度，在四部分骨折病例中较低。
对于年轻患者，使用锁定加压钢板手术治疗肱骨近端稳定的三部分骨折应是首选治疗方法。鉴于效果不佳，对于涉及四部分骨折的治疗选择应个体化定制。
