Department of Orthopaedic Surgery, Resarch 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.
Department of Preventive and Occupational Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):2937-2942. doi: 10.1007/s00068-021-01630-2. Epub 2021 Mar 17.
This study aimed to evaluate the results of surgical treatment for proximal humeral fractures using a locking plate in patients aged > 70 years.
Between September 2010 and March 2018, we retrospectively analyzed the clinical and radiological outcomes of 56 patients aged > 70 years who underwent locking plate fixation for proximal humeral fractures. We analyzed bone union, neck-shaft angle, University of California Los Angeles (UCLA) score, range of motion (compared to that of the opposite side), and complications. Further, clinical and radiological results of unstable medial column fractures were investigated.
Fifty-four patients (96.2%) achieved bone union. The mean time to bone union was 14.7 ± 1.2 weeks, and the mean neck-shaft angle was 126.4° ± 14.2°. The mean UCLA shoulder score was 22.4 ± 6.5. The mean forward flexion, abduction, and external rotation angles were 129.2° ± 19.4°, 112.3° ± 14.8°, and 44.2° ± 18.5°, respectively, with internal rotation to L2/3 (S-T11). The range of motion was significantly different from that in the opposite shoulder motion. Unstable medial column fractures led to a significant loss in the neck-shaft angle compared with fractures with an intact medial cortex.
For the surgical treatment of proximal humeral fractures in patients aged > 70 years, using a locking plate helped achieve a high bone union rate with relatively satisfactory results. However, the prevalence of unstable medial column fracture was high. Clinical and radiological outcomes were poor in these patients. Therefore, it is necessary to accurately understand the fracture pattern prior to surgery, and various surgical methods, including conservative treatment, should be considered.
本研究旨在评估锁定钢板治疗 70 岁以上患者肱骨近端骨折的手术治疗效果。
2010 年 9 月至 2018 年 3 月，我们回顾性分析了 56 例 70 岁以上接受锁定钢板固定治疗肱骨近端骨折患者的临床和影像学结果。我们分析了骨愈合、颈干角、加利福尼亚大学洛杉矶分校（UCLA）评分、活动范围（与对侧相比）和并发症。此外，还研究了不稳定内侧柱骨折的临床和影像学结果。
54 例患者（96.2%）达到骨愈合。骨愈合的平均时间为 14.7±1.2 周，平均颈干角为 126.4°±14.2°。UCLA 肩部评分平均为 22.4±6.5。前屈、外展和外旋的平均角度分别为 129.2°±19.4°、112.3°±14.8°和 44.2°±18.5°，内旋至 L2/3（S-T11）。活动范围与对侧肩部运动明显不同。不稳定的内侧柱骨折与完整内侧皮质骨折相比，颈干角显著丢失。
对于 70 岁以上患者肱骨近端骨折的手术治疗，使用锁定钢板有助于获得较高的骨愈合率，且结果相对满意。然而，不稳定内侧柱骨折的发生率较高。这些患者的临床和影像学结果较差。因此，术前有必要准确了解骨折模式，应考虑包括保守治疗在内的各种手术方法。
