Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital. 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N 28004, Madrid, Spain.
Department of Surgery, Complutense University, Madrid, Spain.
Arch Orthop Trauma Surg. 2022 Feb;142(2):227-238. doi: 10.1007/s00402-020-03678-y. Epub 2020 Nov 11.
Antegrade insertion of third-generation intramedullary nail (IMN) has been shown to provide excellent results in young patients for treatment of displaced two-part surgical neck fracture. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. The purpose of this study was to report the health-related quality of life (HRQoL), functional results, and postoperative complications obtained with straight third-generation antegrade nailing of proximal humerus fractures (PHFs) in elderly patients.
A retrospective review of 32 patients aged 80 y.o. or older presenting a two-part or three-part PHFs treated with a straight IMN with a minimum follow-up of 12 months. Results assessed included 1) radiographic measures 2) clinical data: Charlson Comorbidity Index (CCI), VAS, range of motion (ROM), Individual Relative Constant score (IRC), Simple Shoulder Test (SST) and 3) Health-related Quality of life (HRQoL) with the EQ-5D index/EQ-VAS.
Mean age was 82.1 (range 80-90) and mean follow-up was 45.6 months (range 16-53 months) with 91% of female patients and a mean CCI 4.6. 81% were two-part surgical neck fractures and 19% were three-part greater tuberosity fractures. The mean neck-shaft angle (NSA) at final follow-up was 132º ± 17.9º. 15.6% underwent hardware removal because of subacromial impingement and one patient (3%) was revised to RSA because of severe secondary fracture displacement. Mean IRC was 67,7 ± 30, the mean SST and VAS-Pain were 8.1 ± 3.1 and 3.2 ± 3.2, respectively, and the mean EQ-5D/EQ-VAS were 0.40 ± 0.33/64.2 ± 8.9. At last review, mean active forward flexion, abduction, and external rotation were 115º ± 35º, 100º ± 35º, and 20º ± 15º, respectively.
Appropriate selection of fracture and proper operative technique with a third-generation nail result in good functional results and good HRQol with a low complication rate in elderly population.
顺行插入第三代髓内钉（IMN）已被证明可在年轻患者中为治疗移位的外科颈二部分骨折提供出色的结果。在老年患者中，骨质疏松症使内固定变得困难，并经常导致固定失败和临床效果不佳。本研究的目的是报告使用第三代直型髓内钉治疗老年患者肱骨干骨折（PHF）后的健康相关生活质量（HRQoL）、功能结果和术后并发症。
回顾性分析了 32 名 80 岁或以上的患者，他们患有二部分或三部分 PHF，接受了直型 IMN 治疗，随访时间至少为 12 个月。评估的结果包括 1）影像学测量 2）临床数据：Charlson 合并症指数（CCI）、VAS、活动范围（ROM）、个体相对常数评分（IRC）、简单肩部测试（SST）和 3）使用 EQ-5D 指数/EQ-VAS 的健康相关生活质量（HRQoL）。
平均年龄为 82.1 岁（80-90 岁），平均随访时间为 45.6 个月（16-53 个月），女性患者占 91%，CCI 平均为 4.6。81%为外科颈二部分骨折，19%为大结节三部分骨折。最终随访时的平均颈干角（NSA）为 132°±17.9°。15.6%因肩峰下撞击而接受了内固定去除，1 名患者（3%）因严重的继发性骨折移位而改为 RSA。IRC 平均为 67.7±30，平均 SST 和 VAS 疼痛分别为 8.1±3.1 和 3.2±3.2，平均 EQ-5D/EQ-VAS 为 0.40±0.33/64.2±8.9。最后一次复查时，平均主动前屈、外展和外旋分别为 115°±35°、100°±35°和 20°±15°。
在老年人群中，选择合适的骨折类型并采用第三代髓内钉进行适当的手术技术可获得良好的功能结果和良好的 HRQoL，同时并发症发生率较低。
