Département de chirurgie orthopédique et traumatologie, Hopital Saint Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Département de chirurgie orthopédique et traumatologie, Hopital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France.
Int Orthop. 2021 Jul;45(7):1811-1816. doi: 10.1007/s00264-021-04967-w. Epub 2021 Feb 24.
Surgical treatment of three or four part fractures of the proximal humerus is complex. Different conservative techniques have been described. The main goal of this study was to compare the clinical and radiological outcomes of Bilboquet and locking plate at two year follow-up.
This is a retrospective, comparative study, with a continuous series of 41 patients. Bony fixation was achieved with a Bilboquet device in 22 patients or a locking plate in 19 patients. Patient evaluation included clinical data: shoulder range of motion, Constant-Murley shoulder score and DASH (Disabilities of the Arm, Shoulder and Hand) score, and imaging using standard shoulder X-rays.
Of the 41 patients included, 1 patient was lost to follow-up in the locking plate group. At a mean follow-up of 24 months patients in Bilboquet group showed a Constant score higher than in locking plate (p = 0.02). Range of motion and DASH score were not significantly different between the two groups. avascular necrosis occured in three patients of Bilboquet group (14%) versus in two patients in the locking plate group (11%) (p > 0.5). Complication and reintervention rate were non-significantly higher in the locking plate group than in the Bilboquet group (37 vs 14%).
Bilboquet and locking plate give good functional outcomes in complex proximal humerus fractures. However, the Bilboquet device appears to provide better functional results than locking plate at mid-term follow-up.
肱骨近端三或四部分骨折的手术治疗较为复杂。已经描述了不同的保守技术。本研究的主要目的是比较 Bilboquet 和锁定板在两年随访时的临床和影像学结果。
这是一项回顾性、对照研究，连续纳入了 41 例患者。22 例患者采用 Bilboquet 装置进行骨固定，19 例患者采用锁定板。患者评估包括临床数据：肩关节活动范围、Constant-Murley 肩关节评分和 DASH（上肢、肩和手残疾）评分，以及使用标准肩部 X 线进行影像学评估。
在 41 例纳入的患者中，1 例在锁定板组失访。在平均 24 个月的随访中，Bilboquet 组的 Constant 评分高于锁定板组（p=0.02）。两组间的活动范围和 DASH 评分无显著差异。Bilboquet 组有 3 例（14%）发生骨坏死，锁定板组有 2 例（11%）（p＞0.5）。锁定板组的并发症和再次干预率高于 Bilboquet 组（37%比 14%），但无统计学差异。
在复杂的肱骨近端骨折中，Bilboquet 和锁定板均可获得良好的功能结果。然而，在中期随访中，Bilboquet 装置似乎比锁定板提供更好的功能结果。
