Orthopaedic and Traumatology Department, S. Spirito Hospital, Rome, Italy.
Orthopaedic and Traumatology Department, Nuova Itor Clinic, Rome, Italy.
Injury. 2019 Jul;50 Suppl 2:S34-S39. doi: 10.1016/j.injury.2019.01.042. Epub 2019 Feb 2.
Purpose of this study was to analyse the medium term follow-up of minimally invasive plate osteosynthesis (MIPO) for proximal humeral fractures in terms of postoperative shoulder function, radiological outcome and complications.
76 consecutive patients with unstable proximal humeral fractures were treated using locking plate with a minimally invasive antero-lateral approach in two surgical centers. Constant score and radiographic evaluation of 74 patients were available at mean follow up of 5 years (minimum 4 years).
Mean Constant score was 74 (range to 28-100). Results were comparable in the two centers. Younger patients registered significantly higher scores (p < 0.05). 20 patients (27%) developed complications. Subacromial impingement occurred in 16,2% of cases for varus malreduction (6,7%) and for too proximal plate positioning (9,5%). Primary screws perforation (2,7%), secondary perforation due to cut-out (1,4%), avascular necrosis (AVN) of humeral head (1,4%), partial resorption of greater tuberosity (2,7%), secondary displacement of the greater tuberosity (2,7%) and stiffness (2,7%) were observed.
Even at a medium term follow-up, MIPO for proximal humeral fractures ensured good and reproducible results for most common pattern of fractures. Major complications were lower respect to open procedures, because of soft tissue, deltoid muscle and circumflex vessels sparing.
本研究旨在分析微创钢板接骨术（MIPO）治疗不稳定型肱骨近端骨折的中期随访结果，包括术后肩关节功能、影像学结果和并发症。
在两个外科中心，采用微创前外侧入路的锁定钢板治疗 76 例连续不稳定型肱骨近端骨折患者。74 例患者的Constant 评分和影像学评估在平均 5 年（最短 4 年）的随访时可用。
平均 Constant 评分为 74 分（范围为 28-100 分）。两个中心的结果相当。年轻患者的评分明显更高（p<0.05）。20 例（27%）发生并发症。肩峰下撞击征在 16.2%的病例中发生，其中 6.7%为内翻畸形复位不良，9.5%为钢板位置过高。主要螺钉穿孔（2.7%）、因切出导致的二次穿孔（1.4%）、肱骨头缺血性坏死（AVN）（1.4%）、大结节部分吸收（2.7%）、大结节继发性移位（2.7%）和僵硬（2.7%）。
即使在中期随访中，MIPO 治疗肱骨近端骨折对于大多数常见类型的骨折也能确保良好且可重复的结果。由于软组织、三角肌和旋肱血管的保留，主要并发症低于开放手术。
