Department of Trauma and Orthopaedic Surgery, Ludwig-Maximilians-University, Munich, Germany.
Department of Trauma and Orthopaedic Surgery, Ludwig-Maximilians-University, Munich, Germany.
J Shoulder Elbow Surg. 2014 Aug;23(8):1223-31. doi: 10.1016/j.jse.2013.11.009. Epub 2014 Feb 16.
Locked plating has become an accepted treatment for displaced fractures of the proximal humerus. However, to our knowledge, long-term outcomes have not been reported.
Between February 2002 and March 2004, 121 patients with displaced proximal humeral fractures were treated by open reduction and locking plate fixation. Forty-three patients were available for 10-year (95% confidence interval [CI], 9.8-10.1) follow-up, including Constant score (CS), Disabilities of the Arm, Shoulder and Hand score, and Short Form 36 questionnaire.
Of 43 patients (72% women; mean age at time of fracture repair, 58.2 years; 95% CI, 54.2-62.2), the absolute CS 10 years after surgery was 75.3 (95% CI, 69.2-81.4). The normalized CS was 88.4 (95% CI, 81.7-95.1), and the CS in percentage to the contralateral side (%CS) was 83.7 (95% CI, 78.5-88.9). In contrast, at 1 year, the CS was 73.9 (95% CI, 67.8-80.2, P = .774), the normalized CS was 87.2 (95% CI, 80.4-94.0; P = .765), and the %CS was 78.7 (95% CI, 71.5-85.8; P = .355). The CS at 10 years correlated with the CS at 1 year after surgery (r = 0.460; P < .01) and with patient gender (r = -0.424; P < .01), and it strongly correlated with patient age (r = -0.545; P < .001).
Ten years after locked plating of displaced proximal humeral fractures, patients show good to excellent outcomes in the majority of cases with no relevant decline compared with the shoulder function 1 year after surgery. However, poor long-term outcome is seen in 16% of patients and relates to a low CS 1 year after surgery. Thus, patients developing poor long-term outcomes may be identified at an earlier stage.
锁定钢板已成为治疗移位性肱骨近端骨折的一种公认的治疗方法。然而，据我们所知，尚未报道其长期结果。
2002 年 2 月至 2004 年 3 月，对 121 例移位性肱骨近端骨折患者行切开复位和锁定钢板固定。43 例患者获得 10 年（95%置信区间[CI]，9.8-10.1）随访，包括 Constant 评分（CS）、上肢功能障碍评分（DASH）和简短 36 项健康调查量表（SF-36）问卷。
43 例患者中（72%为女性；骨折修复时的平均年龄为 58.2 岁；95%CI，54.2-62.2），术后 10 年 CS 的绝对值为 75.3（95%CI，69.2-81.4）。标准化 CS 为 88.4（95%CI，81.7-95.1），对侧 CS 的百分比（%CS）为 83.7（95%CI，78.5-88.9）。相比之下，术后 1 年 CS 为 73.9（95%CI，67.8-80.2，P=.774），标准化 CS 为 87.2（95%CI，80.4-94.0；P=.765），%CS 为 78.7（95%CI，71.5-85.8；P=.355）。术后 10 年 CS 与术后 1 年 CS 呈正相关（r=0.460；P<.01），与患者性别呈负相关（r=-0.424；P<.01），与患者年龄呈强负相关（r=-0.545；P<.001）。
肱骨近端骨折经锁定钢板固定 10 年后，多数患者的肩关节功能恢复良好或极好，与术后 1 年相比无明显下降。然而，仍有 16%的患者预后较差，与术后 1 年 CS 较低有关。因此，可能更早地识别出预后较差的患者。
