Padolino A, Porcellini G, Guollo B, Fabbri E, Kiran Kumar G N, Paladini P, Merolla G
Shoulder and Elbow Unit, Cervesi Hospital, Cattolica - AUSL della Romagna, Ambito Territoriale di Rimini, Cattolica, Italy.
Research and Innovation Department - AUSL della Romagna, Ambito Territoriale di Rimini, Rimini, Italy.
Musculoskelet Surg. 2018 Oct;102(Suppl 1):49-56. doi: 10.1007/s12306-018-0562-8. Epub 2018 Oct 20.
Metal plates are the fixation devices used most frequently to proximal humeral fractures (PHFs). However, in recent years carbon fiber-reinforced polyetheretherketone (CFR-PEEK) plates have become increasingly common. This study compares the clinical and radiographic outcomes of 42 Neer three- and four-part PHFs treated with CFR-PEEK or metal (titanium) plates.
Forty-two PHF patients were managed with CFR-PEEK plates (n = 21, males/females 9/12; mean age 57.4 years; mean follow-up 30.7 months; CFR-PEEK group) or metal plates (n = 21; males/females 7/14; mean age 55.8 years; mean follow-up 52.7 months; Metal group). Active shoulder mobility (anterior elevation, lateral elevation, external rotation, and internal rotation), the Constant-Murley Score, the Simple Shoulder Test Score, and the pain score were recorded. Preoperative computed tomography scans and X-rays were obtained. Postoperative fracture healing and displacement, tuberosity resorption and/or malposition, hardware position, and cortical thinning (CT) under the plate were assessed radiographically.
Shoulder mobility, clinical, and pain scores were similar in both patient groups. CT was significantly greater in CFR-PEEK patients (mean difference, 1.14 mm; p = 0.0003). In both groups, incomplete or poor calcar reduction was associated to a significantly higher complication rate, especially stiffness and muscle weakness (p = 0.016). The rate of tuberosity resorption was significantly higher in the Metal group (p = 0.040). Two patients required revision to a hemiarthroplasty (CFR-PEEK) and reverse arthroplasty (Metal group).
CFR-PEEK plates provide a viable alternative to conventional titanium plates in PHFs, ensuring similar clinical outcomes and a lower rate of tuberosity resorption, but they involve higher stress shielding under the plate.
金属板是治疗肱骨近端骨折（PHF）最常用的固定装置。然而，近年来，碳纤维增强聚醚醚酮（CFR-PEEK）板越来越普遍。本研究比较了42例采用CFR-PEEK或金属（钛）板治疗的Neer三部分和四部分PHF的临床和影像学结果。
42例PHF患者采用CFR-PEEK板治疗（n = 21，男/女9/12；平均年龄57.4岁；平均随访30.7个月；CFR-PEEK组）或金属板治疗（n = 21；男/女7/14；平均年龄55.8岁；平均随访52.7个月；金属组）。记录肩关节活动度（前屈、外展、外旋和内旋）、Constant-Murley评分、简单肩关节测试评分和疼痛评分。术前进行计算机断层扫描和X线检查。术后通过影像学评估骨折愈合和移位情况、结节吸收和/或错位、内固定位置以及钢板下皮质变薄情况（CT）。
两组患者的肩关节活动度、临床和疼痛评分相似。CFR-PEEK组患者的CT值明显更高（平均差异为1.14 mm；p = 0.0003）。在两组中，大转子复位不完全或不佳与并发症发生率显著升高相关，尤其是僵硬和肌肉无力（p = 0.016）。金属组的结节吸收发生率明显更高（p = 0.040）。2例患者需要翻修为半关节置换术（CFR-PEEK组）和反式关节置换术（金属组）。
在PHF治疗中，CFR-PEEK板是传统钛板的可行替代方案，可确保相似的临床结果和较低的结节吸收发生率，但钢板下的应力遮挡更高。
