Szczęsny Grzegorz, Ratajczak Karol, Fijewski Grzegorz, Małdyk Paweł
Klinika Ortopedii i Traumatologii Narządu Ruchu Warszawskiego Uniwersytetu Medycznego, Warszawa / Department of Orthopedics and Traumatology of the Musculoskeletal System, Medical University of Warsaw, Poland.
Ortop Traumatol Rehabil. 2019 Aug 31;21(4):297-305. doi: 10.5604/01.3001.0013.5075.
An 86-year-old female was operated on due to a comminuted fracture of the right proximal humerus whose configu-ration necessitated over-screwing of the humeral head to improve stability, with the screws directed divergently: anteriorly and poste-riorly, to minimize their conflict with the acetabulum. 3.5 years later she sustained a corresponding fracture of the left shoulder which was stabilized without over-screwing. On both occasions, the fractures were stabilized with titanium interlocking plates (ChM, Poland) and the limbs were immobilized in a shoulder brace for three weeks followed by in-tensive rehabilitation. The patient attended a follow-up visit at 12 months (i.e. 52 months post the right shoulder fracture) which included an assess-ment of radiographs, pain and limb function as well as tests of the range of movement of the shoulder and girdle. Assessments were repeated at 12 and 18 months afterwards. Patient denied limb pain and dysfunction. Abduction was reduced by 20°, which was compensated for by the scapulothoracic joint. Shoulder (girdle) abduction reached 50° (150°) for the right and 70° (170°) for the left extremity. Flexion was reduced by 20°, but extension and rotations were comparable. At 12 months post fracture, no improvement of limb mobility was noted despite continued intensive physiotherapy. X-rays showed satisfactory bone union. The patient scored 87 for the right and 89 for the left shoulder according to the Con-stant score and 6.8 points for each limb according to the QuickDash score. Overscrewing of the humeral head is not the most beneficial method for improving stability of comminuted proximal humeral fractures; however, it may be used when alternative and more suitable methods are unavailable. Moreover, directing screws divergently anteriorly and posteriorly to minimize their conflict with the scapular acetabulum does not interfere with joint function outcomes.
一名86岁女性因右肱骨近端粉碎性骨折接受手术，骨折形态需要对肱骨头进行过度拧入螺钉以提高稳定性，螺钉向前后方向发散，以尽量减少与髋臼的冲突。3.5年后，她左侧肩部发生了相应骨折，未进行过度拧入螺钉就实现了骨折固定。两次骨折均采用钛合金锁定钢板（波兰ChM公司）固定，患肢用肩托固定三周，随后进行强化康复治疗。患者在12个月时（即右肩骨折后52个月）进行了随访，包括对X光片、疼痛和肢体功能的评估，以及肩部和肩胛带活动范围的测试。此后在12个月和18个月时重复进行评估。患者否认肢体疼痛和功能障碍。外展减少了20°，由肩胛胸壁关节代偿。右上肢肩部（肩胛带）外展达到50°（正常150°），左上肢达到70°（正常170°）。屈曲减少了20°，但伸展和旋转功能相当。骨折后12个月，尽管持续进行强化物理治疗，但肢体活动度未见改善。X光显示骨折愈合良好。根据Constant评分，患者右肩评分为87分，左肩评分为89分；根据QuickDash评分，双上肢各得6.8分。对肱骨头进行过度拧入螺钉并非改善肱骨近端粉碎性骨折稳定性的最有益方法；然而，当没有其他更合适的方法时，可以使用这种方法。此外，将螺钉向前后方向发散以尽量减少与肩胛髋臼的冲突，并不影响关节功能结果。
