Erdoğan Murat, Desteli Engin Eren, İmren Yunus, Üztürk Ali, Kılıç Mesut, Sezgin Hicabi
Department of Orthopaedics and Traumatology, Ondokuz Mayıs University, Samsun, Turkey,
Eur J Orthop Surg Traumatol. 2014 Oct;24(7):1055-9. doi: 10.1007/s00590-013-1391-y. Epub 2013 Dec 12.
The aim of the study was to evaluate the clinical and radiologic results of locking plate fixation with or without inferomedial screw (IMS) in surgically treated proximal humerus fractures.
Thirty-six patients with displaced proximal humerus fractures from two centers were operated using locking plate. All of the fractures were classified according to the Neer classification. In 18 of the cases, an additional IMS running through the medial curvature of the surgical neck was used. There was no significant difference among both groups in terms of height, gender, weight, and mechanism of injury. The fractures were evaluated according to the radiographic and functional findings during follow-up period of 14 months in average (range 8-32 months). At the end of first year, shoulder radiographs were received and shoulder examinations were performed using ASES scores. Humeral head-shaft angles were measured by true AP projections. Head-shaft angle measurements were categorized as varus if <125, normal if between 125 and 145, and valgus if >145.
Mean time for fracture healing was 18 weeks. Complete union was achieved in 35 patients by the end of 6 months. In one of the 18 displaced proximal humerus fractures of IMS (+) group, the head-shaft angle was measured to be <125, whereas six patients had varus deviation in IMS (-) group at follow-up (p < 0.05). Mean ASES scores of IMS (+) group and IMS (-) group were 58.21 ± 5.82 and 38.61 ± 3.44, respectively (p < 0.001).
Use of inferomedial screw running through the medial curvature of surgical neck prevents varus deformity and improves functional outcome after surgical treatment for proximal humerus fractures.
本研究旨在评估在手术治疗肱骨近端骨折时，使用或不使用内侧下螺钉（IMS）的锁定钢板固定的临床和影像学结果。
来自两个中心的36例移位肱骨近端骨折患者接受了锁定钢板手术。所有骨折均根据Neer分类法进行分类。其中18例患者使用了一枚贯穿手术颈内侧弯曲处的额外IMS。两组患者在身高、性别、体重和损伤机制方面无显著差异。在平均14个月（范围8 - 32个月）的随访期内，根据影像学和功能检查结果对骨折进行评估。在第一年末，拍摄肩部X线片，并使用ASES评分进行肩部检查。通过真正的前后位投照测量肱骨头-骨干角。如果肱骨头-骨干角<125°，则分类为内翻；如果在125°至145°之间，则为正常；如果>145°，则为外翻。
骨折愈合的平均时间为18周。到6个月末，35例患者实现了完全愈合。在IMS（+）组的18例移位肱骨近端骨折中，有1例测量的肱骨头-骨干角<125°，而在随访时，IMS（-）组有6例患者出现内翻畸形（p<0.05）。IMS（+）组和IMS（-）组的平均ASES评分分别为58.21±5.82和38.61±3.44（p<0.001）。
使用贯穿手术颈内侧弯曲处的内侧下螺钉可预防肱骨近端骨折手术治疗后的内翻畸形，并改善功能结果。
