Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
J Shoulder Elbow Surg. 2021 Sep;30(9):2065-2072. doi: 10.1016/j.jse.2020.11.029. Epub 2021 Jan 20.
Bone grafts have been used for augmentation and improving stability of reduced fractures in proximal humeral fractures. The aim of this study was to analyze the clinical and radiological outcomes after the use of cancellous bone allografts (CAs) for augmentation in 3- or 4-part proximal humeral fractures, and compare with fibular strut allografts (FAs).
Between November 2016 and February 2018, 55 patients, followed for at least 1 year, with 3- or 4-part proximal humeral fractures fixed with locking plates were included and grouped according to the type of allograft bone used for augmentation. In this retrospective analysis, we assessed and compared the clinical and radiological outcomes of the 2 groups, using the visual analog scale score, the Constant-Murley score (CMS), the disability of the arm, shoulder, and hand (DASH) score, the range of movement, neck-shaft angle (NSA), humeral head height (HHH), and the changes of NSA and HHH, as well as recording any complications. The repeatedly measured clinical and radiological outcomes were analyzed by linear mixed models. The differences in outcomes between groups at the final follow-up were compared using Student's t test.
There were 28 patients in the CA group and 27 patients in the FA group with an average follow-up of 14.5 months. The mean age of all patients was 64 (36-86). Nonsignificant group effects were observed on CMS (β = -8.792, P = .216), DASH (β = 1.329, P = .094), NSA (β = 1.432, P = .752), and HHH (β = 1.660, P = .628). At the final follow-up, the patients in the CA group showed no significant differences in visual analog scale (1.8 vs. 2.2, P = .276), CMS (81.5 vs. 75.4, P = .072), and DASH (11.0 vs. 13.5, P = .235) scores compared with the FA group. There were no significant differences in the change of NSA (6 vs. 4, P = .387) or HHH (1 vs. 2, P = .261).
Patients with 3- or 4-part proximal humeral fractures treated with locking plates combined with CAs have good clinical and radiographic outcomes, similar to those treated with FAs.
骨移植已被用于增加和稳定肱骨近端骨折的减少骨折。本研究的目的是分析使用松质骨同种异体移植物（CA）进行 3 或 4 部分肱骨近端骨折增强后的临床和影像学结果，并与腓骨支柱同种异体移植物（FA）进行比较。
2016 年 11 月至 2018 年 2 月，55 例 3 或 4 部分肱骨近端骨折患者接受锁定钢板固定，随访至少 1 年，根据增强用同种异体骨的类型分组。在这项回顾性分析中，我们使用视觉模拟量表评分、Constant-Murley 评分（CMS）、手臂、肩部和手部残疾（DASH）评分、活动范围、颈干角（NSA）、肱骨头高度（HHH）以及 NSA 和 HHH 的变化来评估和比较两组的临床和影像学结果，并记录任何并发症。通过线性混合模型分析反复测量的临床和影像学结果。使用学生 t 检验比较最终随访时两组之间的结果差异。
CA 组 28 例，FA 组 27 例，平均随访 14.5 个月。所有患者的平均年龄为 64（36-86）岁。CMS（β=-8.792，P=0.216）、DASH（β=1.329，P=0.094）、NSA（β=1.432，P=0.752）和 HHH（β=1.660，P=0.628）方面未观察到组间有显著差异。在最终随访时，CA 组患者的视觉模拟量表评分（1.8 分对比 2.2 分，P=0.276）、CMS（81.5 分对比 75.4 分，P=0.072）和 DASH（11.0 分对比 13.5 分，P=0.235）评分与 FA 组无显著差异。NSA（6 对比 4，P=0.387）或 HHH（1 对比 2，P=0.261）的变化无显著差异。
接受锁定钢板联合 CA 治疗的 3 或 4 部分肱骨近端骨折患者具有良好的临床和影像学结果，与接受 FA 治疗的患者相似。
