采用专用外固定架治疗 188 例肱骨近端骨折的结果，随访时间 2 至 12 年。
Outcomes of 188 Proximal Humeral Fractures Treated with a Dedicated External Fixator with Follow-up Ranging from 2 to 12 Years.
机构信息
Orthopedics and Traumatology Department, Mauriziano-Umberto I Hospital, Turin, Italy.
Orthopedics and Traumatology Department, ASL To4 Ciriè Hospital, Turin, Italy.
出版信息
J Bone Joint Surg Am. 2019 Sep 18;101(18):1654-1661. doi: 10.2106/JBJS.18.00734.
BACKGROUND
The treatment of a displaced proximal humeral fracture is still a matter of controversy. Minimally invasive techniques are considered promising options. The purpose of this study was to report outcomes at medium to long-term follow-up after surgical treatment with pins stabilized with an external fixator.
METHODS
A total of 235 patients (average age, 64 years [95% confidence interval (CI), 62 to 65 years]) were treated with closed or open reduction and fixation with pins stabilized by an external fixator specifically designed for proximal humeral fractures. The pins were inserted using a "pins-crossing-fracture" or a "pins-bridging-fracture" technique. One hundred and eighty-eight patients had a minimum radiographic and clinical follow-up of 2 years. Outcomes were assessed using the Oxford Shoulder Score (OSS), the subjective shoulder value (SSV), a visual analog scale (VAS) for pain, and, for 155 patients, the Constant score.
RESULTS
Eighty-one (43%) of the 188 patients had a 2-part fracture, 60 (32%) had a 3-part fracture, and 47 (25%) had a 4-part fracture. The reduction was performed with percutaneous maneuvers in 120 shoulders or a deltopectoral approach, in 68. The external fixator was applied using a "pins-crossing-fracture" technique in 133 shoulders and using a "pins-bridging-fracture" technique in 55. At last follow-up, mean clinical scores were as follows: OSS, 42.6 (95% CI, 42 to 44); SSV, 85.5 (95% CI, 83 to 88); and VAS for pain, 1 (95% CI, 0.7 to 1.2). The complication rate at 3 months was 16% (37 of 235). The most frequent complication was pin-track infection (19 of 235, 8%). A total of 50 patients had ≥1 complication (50 of 188, 27%) and 6 (3%) underwent revision surgery. More complications were observed with the "pins-crossing-fracture" technique.
CONCLUSIONS
In our experience, the use of the external fixator has been a valuable option in the treatment of proximal humeral fractures. The complication and revision rates were acceptable. Most of the complications encountered were manageable without revision surgery.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
移位的肱骨近端骨折的治疗仍然存在争议。微创技术被认为是有前途的选择。本研究的目的是报告使用专门设计用于肱骨近端骨折的外固定器固定钢针治疗后的中至长期随访结果。
方法
总共 235 名患者（平均年龄 64 岁[95%置信区间（CI），62 至 65 岁]）接受了闭合或切开复位和钢针固定治疗，钢针使用特定的外固定器固定。针采用“针交叉骨折”或“针桥接骨折”技术插入。188 名患者的最低影像学和临床随访时间为 2 年。使用牛津肩部评分（OSS）、主观肩部值（SSV）、疼痛视觉模拟量表（VAS）和 155 名患者的 Constant 评分评估结果。
结果
188 名患者中有 81 名（43%）为 2 部分骨折，60 名（32%）为 3 部分骨折，47 名（25%）为 4 部分骨折。120 名肩部采用经皮操作或三角肌入路进行复位，68 名采用外固定器。133 名肩部采用“针交叉骨折”技术，55 名肩部采用“针桥接骨折”技术应用外固定器。末次随访时，平均临床评分如下：OSS，42.6（95%CI，42 至 44）；SSV，85.5（95%CI，83 至 88）；VAS 疼痛评分，1（95%CI，0.7 至 1.2）。3 个月时的并发症发生率为 16%（37/235）。最常见的并发症是钢针道感染（235 例中有 19 例，8%）。共有 50 名患者（188 名中的 50 名，27%）有≥1 种并发症，6 名（3%）接受了翻修手术。“针交叉骨折”技术的并发症更多。
结论
根据我们的经验，在外固定器的治疗中，肱骨近端骨折是一种有价值的选择。并发症和翻修率是可以接受的。大多数遇到的并发症都可以在不进行翻修手术的情况下得到控制。
证据水平
治疗 IV 级。有关证据水平的完整说明，请参见作者说明。
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