Katthagen J Christoph, Lutz O, Voigt C, Lill H, Ellwein A
Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hannover, Germany.
2Department of Trauma, Hand and Reconstructive Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Str. 1, 48149 Münster, Germany.
Obere Extrem. 2018;13(2):123-129. doi: 10.1007/s11678-018-0440-x. Epub 2018 Jan 30.
Cement augmentation (CA) of humeral head screws in locked plating of proximal humeral fractures (PHF) was found to be biomechanically beneficial. However, clinical outcomes of this treatment have not been well evaluated to date.
To assess outcomes of locked plating of PHF with additional CA and to compare them with outcomes of conventional locked plating without CA.
24 patients (mean age, 74.2 ± 10.1 years; 22 female) with displaced PHF were prospectively enrolled and treated with locked plating and additional CA. The Constant score (CS), the Simple Shoulder Test (SST), and the Simple Shoulder Value (SSV) were assessed 3 and 12 months postoperatively. Fracture healing and potential complications were evaluated on postoperative radiographs. The CS and complications were compared with the outcomes of a matched group of 24 patients (mean age, 73.9 ± 9.4 years; 22 female) with locked plating of displaced PHF without CA.
At the 3‑month follow-up, the mean CS was 59.9 ± 15.6 points, the mean SST was 7.5 ± 2.7 points, and the mean SSV was 63.9 ± 21.7%. All scores significantly improved by the 12-month follow-up ( < 0.05; CS, 72.9 ± 17.7; SST, 9.2 ± 3.2; SSV, 77.2 ± 17.3%). There were two cases (8%) of biological complications ( = 1 varus malunion and = 1 humeral head necrosis). Compared with locked plating without CA, no significant differences were observed between the CS at the 3‑ (57.8 ± 13.4 points; = 0.62) and 12-month (73.0 ± 12.8 points; = 0.99) follow-up. However, patients without CA had a significantly increased risk of early loss of reduction and articular screw perforation ( = 0.037).
Locked plating of proximal humeral fractures with trauma cement augmentation of humeral head screws could be translated from the ex-vivo lab setting into the clinical situation without additional complications. Locked plating of displaced PHF with additional cement augmentation showed similar clinical outcomes but reduced the rate of early implant-related complications compared to locked plating without additional CA.
在肱骨近端骨折（PHF）锁定钢板固定中，肱骨头螺钉的骨水泥强化（CA）在生物力学方面具有优势。然而，迄今为止，这种治疗方法的临床效果尚未得到充分评估。
评估肱骨近端骨折锁定钢板联合额外骨水泥强化的治疗效果，并与传统无骨水泥强化的锁定钢板治疗效果进行比较。
前瞻性纳入24例移位型肱骨近端骨折患者（平均年龄74.2±10.1岁；女性22例），采用锁定钢板及额外骨水泥强化治疗。术后3个月和12个月评估Constant评分（CS）、简易肩关节测试（SST）和简易肩关节值（SSV）。通过术后X线片评估骨折愈合情况及潜在并发症。将CS和并发症情况与24例匹配的采用无骨水泥强化锁定钢板治疗的移位型肱骨近端骨折患者（平均年龄73.9±9.4岁；女性22例）的结果进行比较。
在3个月随访时，平均CS为59.9±15.6分，平均SST为7.5±2.7分，平均SSV为63.9±21.7%。到12个月随访时，所有评分均显著改善（P<0.05；CS为72.9±17.7；SST为9.2±3.2；SSV为77.2±17.3%）。有2例（8%）发生生物学并发症（1例内翻畸形愈合，1例肱骨头坏死）。与无骨水泥强化的锁定钢板治疗相比，在3个月（57.8±13.4分；P=0.62）和12个月（73.0±12.8分；P=0.99）随访时，CS无显著差异。然而，无骨水泥强化的患者早期复位丢失和关节螺钉穿孔的风险显著增加（P=0.037）。
肱骨头螺钉采用创伤性骨水泥强化的肱骨近端骨折锁定钢板固定可从体外实验环境转化至临床应用，且无额外并发症。与无额外骨水泥强化的锁定钢板治疗相比，移位型肱骨近端骨折锁定钢板联合额外骨水泥强化显示出相似的临床效果，但降低了早期与植入物相关的并发症发生率。
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