Heilmann Lukas F, Katthagen J Christoph, Raschke Michael J, Schliemann Benedikt, Lill Helmut, El Bajjati Hassan, Jensen Gunnar, Dey Hazra Rony-Orijit
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, 48149 Münster, Germany.
Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift and Henriettenstift, 30169 Hannover, Germany.
J Clin Med. 2021 Aug 27;10(17):3841. doi: 10.3390/jcm10173841.
The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus.
Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination.
19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation ( = 11), while most surgical neck fractures were treated with locked plating ( = 6). Patients with impression type fractures showed significantly better ASES scores ( = 0.041), Simple Shoulder Test scores ( = 0.003), Rowe scores ( = 0.013) and WOSI scores ( = 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference.
This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment.
本研究的目的是评估保留肱骨头手术治疗肱骨近端后脱位骨折后的临床疗效。
确定在8年时间内于两个一级创伤中心接受手术治疗的肱骨近端后脱位骨折患者。对随访至少2年的保留肱骨头手术治疗的患者进行检查。
检查了19/24例骨折（79.2%；平均年龄43岁），平均随访4.1±2.1年。其中，12例骨折分类为后脱位压痕型骨折，7例为后脱位外科颈骨折。大多数压痕型骨折采用切开复位、同种异体或自体骨移植嵌压及螺钉固定治疗（n=11），而大多数外科颈骨折采用锁定钢板治疗（n=6）。与后脱位外科颈骨折相比，压痕型骨折患者的ASES评分（P=0.041）、简易肩关节测试评分（P=0.003）、Rowe评分（P=～0.013）和WOSI评分（P=0.023）显著更好。两组的活动范围均为良好至优秀，无显著差异。
这项中期随访研究报告了保留肱骨头治疗的良好至非常好的临床结果。
