Euler Simon A, Hengg Clemens, Wambacher Markus, Spiegl Ulrich J, Kralinger Franz
Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria,
Arch Orthop Trauma Surg. 2015 Jan;135(1):79-87. doi: 10.1007/s00402-014-2128-z. Epub 2014 Dec 9.
The surgical fixation of unstable, varus displaced two-part fractures of the proximal humerus remains challenging.
In a case series of 10 non-compliant, high-risk patients (median age 63 years; range 52-78), a cancellous allograft was used to augment plate fixation of the fractures.
After a median follow-up of 28.5 months, all but one fracture were healed, with the bony allografts incorporated without any systemic or local complications. No significant loss of reduction or evidence of avascular necrosis of the humeral head was seen. The median Constant-Murley Score was 72.0 (range 45-86). Median pain on a visual analog scale was 1 (range 0-7). Median values for the range of motion were flexion: 155° (range 90-170), abduction: 168° (range 95-180) and external rotation: 43° (range: 30-50). Compared to the uninjured contralateral side, flexion was impaired by 13 %, abduction by 14 %, and external rotation by 15 %. Median abduction power was 64 % of the uninjured side. The median varus displacement was 51° (range 45-59) preoperatively, 4° (range -5 to 19) intraoperatively, and 13° (range 1-18) at the time of the final follow-up, relating to an improvement of 38° compared to the preoperative status.
The augmentation of proximal humeral fracture fixation using a cancellous allograft might be a viable and reliable alternative to prevent early varus failure and to, moreover, lead to bony union in a non-compliant or high-risk patient population.
肱骨近端不稳定、内翻移位的两部分骨折的手术固定仍然具有挑战性。
在一组10例不依从、高危患者（中位年龄63岁；范围52 - 78岁）的病例系列中，使用松质骨同种异体骨增强骨折的钢板固定。
中位随访28.5个月后，除1例骨折外其余均愈合，骨同种异体骨融合，未出现任何全身或局部并发症。未观察到明显的复位丢失或肱骨头缺血性坏死的迹象。Constant - Murley评分中位数为72.0（范围45 - 86）。视觉模拟量表上的中位疼痛评分为1（范围0 - 7）。活动范围的中位值为：屈曲155°（范围90 - 170），外展168°（范围95 - 180），外旋43°（范围30 - 50）。与未受伤的对侧相比，屈曲功能受损13%，外展功能受损14%，外旋功能受损15%。外展力量中位数为未受伤侧的64%。术前内翻移位中位数为51°（范围45 - 59），术中为4°（范围 - 5至19），末次随访时为13°（范围1 - 18），与术前状态相比改善了38°。
使用松质骨同种异体骨增强肱骨近端骨折固定可能是一种可行且可靠的替代方法，可预防早期内翻失败，并且能使不依从或高危患者群体实现骨愈合。
