Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Research and Development Department, Schulthess Clinic, Zurich, Switzerland.
Arch Orthop Trauma Surg. 2020 Dec;140(12):1971-1976. doi: 10.1007/s00402-020-03452-0. Epub 2020 Apr 30.
No consensus exists on the optimal treatment of proximal humeral fractures (PHFx). Uncertainty about surgical treatment in the older adults using locking plates (e.g., PHILOS) has emerged, due to a high number of complications. This study aimed to assess the impact of non-operative versus operative treatment of a PHFx on the level of self-dependence in our older population.
We included patients aged over 65 years with some level of self-dependence, treated at our hospital between 5/2011 and 4/2013 for isolated PHFx of AO subtypes A2, A3, and B1 for which either non-operative or surgical treatment using a PHILOS plate had been applied. The patients were questioned, examined, or interviewed via phone; AO fracture patterns and treatment were documented as well as level of self-dependence, complications, constant score (CSM), subjective shoulder value (SSV), quality of life (EQ-5D), and shoulder pain and disability index (SPADI).
Patients with PHFx of AO subtypes A2, A3, or B1 that were either treated non-operative (n = 50) or operative by insertion of the PHILOS plate (n = 63) were included. Operative-treated patients were 3.3 times as likely to lose some level of independence (95% CI 0.39-28, p = 0.271). Shoulder motion, strength, and functional outcomes tended to be lower in operative-treated patients, with adjusted differences of, - 11 CMS points (95% CI - 23 to 2), - 9 SPADI points (95% CI - 18 to 0), and - 6% in SSV (95% CI - 17 to 5). Quality-of-life EQ-5D utility index was similar in both groups (mean - 0.04; 95% CI - 0.18 to 0.10).
In our study population, non-operatively treated older adults with an AO type A2, A3, B1 fracture of the proximal humerus tended to have a high chance to return to their premorbid level of independence, compared to patients treated with a locking plate. A change in the treatment algorithm for these PHFx may be carefully considered and further investigated in clinical practice.
对于肱骨近端骨折（PHFx），目前尚无最佳治疗方法的共识。由于并发症较多，使用锁定钢板（例如 PHILOS）治疗老年人的手术治疗存在不确定性。本研究旨在评估 PHFx 的非手术与手术治疗对我们老年人群体自理能力的影响。
我们纳入了年龄在 65 岁以上、具有一定自理能力的患者，这些患者在 2011 年 5 月至 2013 年 4 月期间在我院因 AO 亚型 A2、A3 和 B1 的孤立性 PHFx 接受治疗，这些患者接受了非手术或使用 PHILOS 板的手术治疗。通过电话对患者进行询问、检查或访谈；记录 AO 骨折类型和治疗方法以及自理能力、并发症、Constant 评分（CSM）、主观肩部值（SSV）、生活质量（EQ-5D）以及肩部疼痛和残疾指数（SPADI）。
纳入了 AO 亚型 A2、A3 或 B1 的 PHFx 患者，分别接受非手术（n=50）或 PHILOS 板插入术（n=63）治疗。接受手术治疗的患者失去某种程度的独立性的可能性是前者的 3.3 倍（95%CI0.39-28，p=0.271）。手术治疗患者的肩部运动、力量和功能结果往往较低，调整后的差异分别为-11CMS 点（95%CI-23 至 2）、-9SPADI 点（95%CI-18 至 0）和-6%的 SSV（95%CI-17 至 5）。两组的生活质量 EQ-5D 效用指数相似（平均-0.04；95%CI-0.18 至 0.10）。
在我们的研究人群中，与接受锁定钢板治疗的患者相比，接受非手术治疗的 A2、A3、B1 型 AO 近端肱骨骨折的老年患者，更有可能恢复到发病前的自理水平。对于这些 PHFx 的治疗方案可能需要仔细考虑，并在临床实践中进一步研究。
