Department of Orthopaedic Surgery, Gil Medical Center, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Republic of Korea.
Arch Orthop Trauma Surg. 2022 Jan;142(1):91-97. doi: 10.1007/s00402-020-03604-2. Epub 2020 Sep 18.
To evaluate the potential of locking compression plate with intramedullary fibular allograft in managing proximal humeral fractures with an unstable medial column.
Between March 2007 and March 2015, we retrospectively analyzed 63 patients who underwent locking plate fixation for proximal humeral fracture with an unstable medial column. All patients were assigned into group 1 (patients treated with locking plate) and group 2 (patients treated with locking plate with intramedullary fibular allograft). Groups 1 and 2 were composed of 29 and 34 patients, respectively. We analyzed bone union, the neck-shaft angle, the Constant score, the range of motion, and complications.
The mean average bone union time of the patients was 13.9 weeks in group 1 and 11.3 weeks in group 2. The average Constant score was 67.4 in group 1 and 73.6 in group 2 (p < 0.05). The mean preoperative NSA, postoperative NSA, and NSA at the last follow-up were 104.4°, 125.8°, and 115.8°, respectively, in group 1, and 109.0°, 130.3°, and 127.1°, respectively, in group 2. The mean forward flexion, abduction, external rotation, and internal rotation were 109.0°, 48.2°, 34.0°, and L5, respectively, in group 1, and 127.5°, 118.2°, 38.7°, and L1, respectively, in group 2. In group 1, avascular necrosis occurred in one patient and screw cutout in two patients. In group 2, screw cutout occurred in one patient.
In patients aged over 65 years with proximal humeral fractures, an unstable medial column was associated with poor clinical results owing to varus collapse. To prevent this, an intramedullary fibular allograft was used, and radiologic and clinical results were better with this approach than with a locking plate alone. Therefore, locking plate fixation using a fibular allograft is one of the possible treatments for patients with an unstable medial column.
评估带髓内腓骨同种异体骨锁定加压钢板在治疗不稳定内侧柱的肱骨近端骨折中的应用潜力。
回顾性分析 2007 年 3 月至 2015 年 3 月采用锁定钢板治疗肱骨近端骨折伴不稳定内侧柱的 63 例患者。所有患者分为组 1（接受锁定钢板治疗的患者）和组 2（接受带髓内腓骨同种异体骨锁定钢板治疗的患者）。组 1 和组 2 分别由 29 例和 34 例患者组成。我们分析了骨愈合、颈干角、Constant 评分、活动范围和并发症。
组 1 患者的平均骨愈合时间为 13.9 周，组 2 患者的平均骨愈合时间为 11.3 周。组 1 的平均 Constant 评分为 67.4 分，组 2 的平均 Constant 评分为 73.6 分（p<0.05）。组 1 患者术前 NSA、术后 NSA 和末次随访时 NSA 分别为 104.4°、125.8°和 115.8°，组 2 患者分别为 109.0°、130.3°和 127.1°。组 1 患者的前屈、外展、外旋和内旋分别为 109.0°、48.2°、34.0°和 L5，组 2 患者的前屈、外展、外旋和内旋分别为 127.5°、118.2°、38.7°和 L1。组 1 中有 1 例发生骨坏死，2 例发生螺钉切出。组 2 中有 1 例发生螺钉切出。
在 65 岁以上伴肱骨近端骨折且内侧柱不稳定的患者中，由于内翻塌陷，导致临床结果较差。为了防止这种情况发生，使用了髓内腓骨同种异体骨，与单独使用锁定钢板相比，这种方法的影像学和临床结果更好。因此，带髓内腓骨同种异体骨的锁定钢板固定是治疗不稳定内侧柱患者的一种可能治疗方法。
