Pineta Grande Hospital, Castel Volturno, Italy.
Vanvitelli University, Naples, Italy.
J Shoulder Elbow Surg. 2020 Sep;29(9):1843-1851. doi: 10.1016/j.jse.2020.01.077. Epub 2020 Apr 22.
An intramedullary augmentation technique using a titanium cage with different types of hardware can be considered a new option in the management of proximal humeral fractures. This study aimed to report the perioperative, early, and late complications of proximal humeral fractures using the intramedullary augmentation technique.
From 2005 to 2017, 142 displaced proximal humeral fractures were treated in the same unit by the aforementioned technique. Perioperative, early, and late complications were evaluated in all patients. Clinical evaluation was performed according to the Constant and Disabilities of the Arm, Shoulder and Hand scores. Only 115 patient records could be considered to have long-term follow-up (7-12 years).
Extra-articular migrations of K-wires, plate cutout, and screw penetration were not observed. A transitory axillary nerve palsy with inferior humeral head subluxation was observed in 41 patients (29.8%). Of the 142 patients, 2 (1.4%) manifested early signs of infection, and 1 underwent a reoperation after 30 days. Complete bone healing was obtained at a mean of 3.5 months in 140 of 142 shoulders (98.6%). We achieved long-term follow-up on only 115 patients because 14 had died, 6 lived abroad, and 7 could not participate due to illness. The results were good or excellent in 99 patients (86%), fair in 12 (10.4%), and poor in 4 (3.4%). K-wires were removed in 15 of 79 patients (11.5%). Nonunion or malunion occurred in 1 patient (0.8%). Asymptomatic avascular necrosis developed in 8 patients (6.9%) after 5 years, and secondary glenohumeral osteoarthritis occurred in 6 (5.2%).
Intraoperative and postoperative analyses with short-, medium-, and long-term outcomes show that the intramedullary augmentation technique improves fracture treatment with significantly good anatomic reconstruction in complex and unstable cases. The bone healing rate is significantly high, and the technique is associated with a significantly low percentage of complications.
使用带有不同类型硬件的钛笼进行髓内增强技术可以被视为治疗肱骨近端骨折的一种新选择。本研究旨在报告使用髓内增强技术治疗肱骨近端骨折的围手术期、早期和晚期并发症。
2005 年至 2017 年，同一单位采用上述技术治疗了 142 例移位的肱骨近端骨折。所有患者均评估围手术期、早期和晚期并发症。临床评估根据 Constant 和 Disabilities of the Arm, Shoulder and Hand 评分进行。只有 115 份患者病历可被认为具有长期随访（7-12 年）。
未观察到关节外 K 线迁移、钢板切割和螺钉穿透。41 例患者（29.8%）出现一过性腋神经麻痹和肱骨头下脱位。在 142 例患者中，2 例（1.4%）出现早期感染迹象，1 例在 30 天后再次手术。142 例肩中有 140 例（98.6%）在平均 3.5 个月时获得完全骨愈合。由于 14 例患者死亡、6 例患者居住在国外以及 7 例患者因疾病无法参加，我们仅对 115 例患者进行了长期随访。结果为优或良的有 99 例（86%），中或差的有 12 例（10.4%）和 4 例（3.4%）。15 例患者中的 79 例（11.5%）取出了 K 线。1 例（0.8%）发生骨不连或畸形愈合。5 年后，8 例（6.9%）患者出现无症状性股骨头缺血性坏死，6 例（5.2%）患者出现继发性肱骨头关节炎。
术中及术后分析以及短期、中期和长期结果表明，髓内增强技术可改善骨折治疗，在复杂和不稳定病例中可实现明显良好的解剖重建。骨愈合率明显较高，并发症发生率明显较低。
