Lill H, Voigt C, Jensen G, Warnhoff M, Katthagen J C
Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH, Humboldtstr. 5, 30169, Hannover, Deutschland,
Unfallchirurg. 2015 Jan;118(1):18-28. doi: 10.1007/s00113-014-2682-4.
Fracture sequelae of proximal humeral fractures arise following nonoperative and operative forms of treatment. Due to a painful restricted range of motion, in most cases shoulder prostheses are implanted. There is a need for joint-preserving alternatives especially for younger patients.
The aim of this study was to evaluate the surgical techniques and prospective results of fracture sequelae of proximal humeral fractures following corrective osteosynthesis.
A total of 11 patients (4 female) with an average age of 53 years (range 29-71 years) and a mean follow-up of 19.5 months were included prospectively. The preoperative and postoperative ranges of motion of the affected shoulder were compared by statistical means. At the time of follow-up the constant score (CS), the simple shoulder test (SST) and the simple shoulder value (SSV) were assessed.
Fracture sequelae were classified as type II in four patients, as type III in two and as type IV in five patients using the Boileau classification. Shoulder flexion (p = 0.006), abduction (p = 0.003) and external rotation (p = 0.02) improved significantly in the postoperative course. The mean age and gender-adapted CS was 74.8 ± 19.9 % at the time of follow-up, 10.1 out of 12 points were reached in the SST and the mean SSV was 77 %.
Corrective osteosynthesis of fracture sequelae (Boileau types II-IV) of proximal humeral fractures appears to be a good alternative to implantation of shoulder prostheses, especially in younger patients (< 60 years of age).
肱骨近端骨折的骨折后遗症出现在非手术和手术治疗之后。由于疼痛导致活动范围受限，在大多数情况下会植入肩关节假体。尤其对于年轻患者，需要有保留关节的替代方案。
本研究的目的是评估肱骨近端骨折骨折后遗症经矫正性骨合成术后的手术技术和前瞻性结果。
前瞻性纳入了11例患者（4例女性），平均年龄53岁（范围29 - 71岁），平均随访19.5个月。通过统计学方法比较患侧肩部术前和术后的活动范围。在随访时评估Constant评分（CS）、简单肩关节测试（SST）和简单肩关节值（SSV）。
根据Boileau分类，4例患者的骨折后遗症为II型，2例为III型，5例为IV型。术后过程中，肩部前屈（p = 0.006）、外展（p = 0.003）和外旋（p = 0.02）显著改善。随访时平均年龄和性别适应性CS为74.8 ± 19.9%，SST在12分中达到10.1分，平均SSV为77%。
肱骨近端骨折骨折后遗症（Boileau II - IV型）的矫正性骨合成似乎是肩关节假体植入的良好替代方案，尤其是对于年龄小于60岁的年轻患者。
