Xue Gang, Chahal Kapil, Lim Thou, Hu Siyuan, Li Shaohua, Liu Jie
Department of Orthopaedic, Shanghai Tenth People's Hospital, Tongji University, 301 Middle Yanchang Road, Shanghai, China.
Department of Orthopaedic, Shanghai Sixth People's Hospital, Jiaotong University, Shanghai, China.
Int Orthop. 2018 Oct;42(10):2467-2473. doi: 10.1007/s00264-018-3823-0. Epub 2018 Mar 3.
Greater tuberosity fractures (GTFs) account for 17 to 21% of proximal humerus fractures, most of these fractures are treated conservatively, but treatment for displaced fractures is still controversial. The aim of this study is to compare intra-operative clinical conditions and post-operative outcomes when displaced GTFs are treated with either proximal humeral internal locking system (PHILOS) or mini locking plate with trans-osseous sutures.
This is a retrospective study conducted in Shanghai Tenth People's Hospital. A total of 60 patients (22 males and 38 females) with displaced humeral GTF between May 2013 and March 2017 were included, of whom 43 underwent PHILOS implant treatment and 17 underwent titanium mini plate implant with trans-osseous suture treatment. Intra-operative (incision size, intra-operative blood loss, operative duration) and postoperative (Constant-Murley score (CMS) and implant cost) variables were recorded for the comparison.
Mini locking plate with trans-osseous sutures shows better results. Operative duration (PHILOS mean 77.0 minutes vs mean 63.7 minutes, p value < 0.05), blood loss during surgery (PHILOS mean 111.5 vs 66.5 ml, p value < 0.05), incision size (PHILOS mean 7.2 vs 4.6 cm, p value < 0.05), CMS (PHILOS mean 81.0 vs 87.3, p value < 0.05), and implant costs (PHILOS mean 26,192.6 renminbi (RMB) vs mean 21,358.8 RMB, p value < 0.05). On the other hand, 9.30% of impingement in the PHILOS group was observed to have no complications compared to the mini locking plate group.
Mini locking plate with trans-osseous sutures shows better efficacy in reducing the incision size, operative duration, intraoperative blood loss, and implant cost and in improving CMS. No complication was found with its use. Our data can provide rationale and inform sample- size calculations for such studies. Larger, control studies are needed for better understanding.
肱骨大结节骨折（GTF）占肱骨近端骨折的17%至21%，这些骨折大多采用保守治疗，但对于移位骨折的治疗仍存在争议。本研究的目的是比较采用肱骨近端锁定接骨板系统（PHILOS）或带骨间缝线的微型锁定钢板治疗移位GTF时的术中临床情况和术后结果。
这是一项在上海第十人民医院进行的回顾性研究。纳入2013年5月至2017年3月期间60例肱骨GTF移位患者（男性22例，女性38例），其中43例行PHILOS植入治疗，17例行带骨间缝线的钛微型钢板植入治疗。记录术中（切口大小、术中失血量、手术时间）和术后（Constant-Murley评分（CMS）和植入物成本）变量进行比较。
带骨间缝线的微型锁定钢板显示出更好的结果。手术时间（PHILOS平均77.0分钟对平均63.7分钟，p值<0.05）、术中失血量（PHILOS平均111.5对66.5毫升，p值<0.05）、切口大小（PHILOS平均7.2对4.6厘米，p值<0.05）、CMS（PHILOS平均81.0对87.3，p值<0.05）和植入物成本（PHILOS平均26,192.6元人民币对平均21,358.8元人民币，p值<0.05）。另一方面，与微型锁定钢板组相比，PHILOS组有9.30%的撞击未出现并发症。
带骨间缝线的微型锁定钢板在减小切口大小、手术时间、术中失血量和植入物成本以及改善CMS方面显示出更好的疗效。使用过程中未发现并发症。我们的数据可为这类研究提供理论依据并指导样本量计算。需要进行更大规模的对照研究以加深理解。
