Chen H, Ji X, Gao Y, Zhang L, Zhang Q, Liang X, Tang P
The Department of Orthopaedic, The General Hospital of People's Liberation Army (301 hospital), 28 Fuxing road, Beijing 100853, PR China.
The Department of Orthopedic, KuanCheng Hospital, KuanCheng, Hebei, PR China.
Orthop Traumatol Surg Res. 2016 May;102(3):287-92. doi: 10.1016/j.otsr.2015.12.021. Epub 2016 Mar 3.
To compare the outcomes of intramedullary fibular allograft (IFA) with locking compression plates (LCPs) versus shoulder hemi-arthroplasty (HA) in osteoporotic four-part proximal humeral fracture (PHF).
Between January 2010 and December 2012, totally 60 cases with osteoporotic four-part PHF were enrolled in this study and were randomly separated into IFA and LCPs group and HA group (n=30). Additionally, surgery indexes for patients in the two groups, such as Constant-Murley score (CMS), the Disability of Arm, Shoulder and Hand (DASH) score, individual subject evaluation of the outcomes, plain X-ray, and computer tomography (CT) scanning were evaluated and compared.
CMS, DASH score, activities of daily living (ADL), and range of motion (ROM) were statistically higher in the IFA and LCPs group than those in the HA group at the last follow-up, whereas the pain were obviously lower than that in the HA group. Besides, patients in the IFA and LCPs group had higher abduction, external rotation with elbow, strength, and satisfactory rating compared with HA group at the last follow-up. However, one case developed avascular necrosis (AVN), one case encountered screw perforation, and one case experienced varus displacement in the IFA and LCPs group, while there were 2, 4, and 2 cases suffered from superficial infection, shoulder stiffness, tuberosity migration in the HA group, respectively.
IFA with LCP have an advantage in functional outcomes than shoulder HA.
Level II. Prospective cohort study.
比较髓内腓骨移植（IFA）联合锁定加压钢板（LCP）与半肩关节置换术（HA）治疗骨质疏松性肱骨近端四部分骨折（PHF）的疗效。
2010年1月至2012年12月，本研究共纳入60例骨质疏松性肱骨近端四部分骨折患者，随机分为IFA联合LCP组和HA组（n = 30）。此外，对两组患者的手术指标进行评估和比较，如Constant-Murley评分（CMS）、上肢、肩部和手部功能障碍评分（DASH）、个体结局评估、X线平片及计算机断层扫描（CT）。
末次随访时，IFA联合LCP组的CMS、DASH评分、日常生活活动能力（ADL）及活动范围（ROM）在统计学上均高于HA组，而疼痛明显低于HA组。此外，末次随访时，IFA联合LCP组患者的外展、屈肘外旋、力量及满意度评分均高于HA组。然而，IFA联合LCP组有1例发生缺血性坏死（AVN），1例出现螺钉穿孔，1例出现内翻移位，而HA组分别有2例、4例和2例发生浅表感染、肩关节僵硬、结节移位。
IFA联合LCP在功能结局方面优于半肩关节置换术。
II级。前瞻性队列研究。
