Department of Orthopaedic Surgery, Tripler Army Medical Center, 1 Jarrett White Road, 4F, Honolulu, HI, 96859, USA.
Harvard University, Cambridge, MA, USA.
Eur J Orthop Surg Traumatol. 2021 Aug;31(6):1105-1112. doi: 10.1007/s00590-020-02841-w. Epub 2021 Jan 4.
The current understanding of the factors associated with a second surgery or loss of alignment after operative treatment of a proximal humerus fracture has relied on small sample studies with stepwise regression analysis. In this study, we used a powerful regression analysis over a large sample and with many variables to test the null hypothesis that there are no factors associated with a revision surgery or loss of alignment after operative treatment of proximal humerus fractures.
A retrospective review of all surgically treated proximal humerus fractures from January 1, 2000, to December 31, 2015, was performed at a tertiary level hospital. We extracted longitudinal medical records for all patients, and the data were organized into two categories of predictors: fracture/operative characteristics and patient characteristics.
During the study period, 423 patients met the inclusion criteria. Three hundred and fourteen of the fractures underwent Open Reduction Internal Fixation (ORIF) and 109 underwent Hemiarthroplasty. Thirty-three patients underwent revision surgery (8%). Seventy-nine patients treated with ORIF had loss of alignment (25%). Across the entire cohort, the least absolute shrinkage selection operator (LASSO) analysis found that patients between 40 and 60 years of age had a higher odds of revision surgery (OR = 1.6). In patients treated with ORIF, the LASSO regression found an unreduced calcar to be the strongest predictor of loss of alignment (OR = 5.5), followed by osteoporosis (OR = 1.3), prior radiation treatment (OR = 1.3), unreduced greater tuberosity (OR = 1.2) and age over 80 years (OR = 1.2).
Reoperation after proximal humerus surgery is infrequent even though loss of alignment is common. In our cohort, not all patients who had a loss of alignment underwent revision surgery; consequently, obtaining the best possible reduction at the index surgery is paramount.
目前，对于肱骨近端骨折手术治疗后再次手术或失对线的相关因素的认识主要依赖于小样本的逐步回归分析研究。在本研究中，我们使用了一种强大的回归分析方法，对大量样本和多个变量进行了检验，以验证手术治疗肱骨近端骨折后再次手术或失对线与任何因素无关的零假设。
对一家三级医院 2000 年 1 月 1 日至 2015 年 12 月 31 日期间所有手术治疗的肱骨近端骨折进行回顾性研究。我们提取了所有患者的纵向病历记录，并将数据分为骨折/手术特征和患者特征两类预测因子。
在研究期间，符合纳入标准的患者有 423 例。其中 314 例骨折采用切开复位内固定（ORIF）治疗，109 例采用半关节成形术治疗。33 例患者接受了翻修手术（8%）。109 例行 ORIF 治疗的患者中有 79 例发生了对线不良（25%）。在整个队列中，最小绝对收缩选择算子（LASSO）分析发现，40 至 60 岁的患者接受翻修手术的可能性更高（OR=1.6）。在接受 ORIF 治疗的患者中，LASSO 回归发现未复位的肱骨小结节是对线不良的最强预测因子（OR=5.5），其次是骨质疏松症（OR=1.3）、先前的放射治疗（OR=1.3）、未复位的大结节（OR=1.2）和 80 岁以上年龄（OR=1.2）。
尽管肱骨近端手术后对线不良很常见，但再次手术并不常见。在我们的队列中，并非所有对线不良的患者都接受了翻修手术；因此，在初次手术中获得尽可能好的复位至关重要。
