Department of Trauma-, Reconstructive- and Plastic Surgery, University of Leipzig, Leipzig, Deutschland.
Z Orthop Unfall. 2023 Aug;161(4):422-428. doi: 10.1055/a-1666-9231. Epub 2022 Feb 1.
Surgical treatment of proximal humerus fracture is an established procedure. Postoperative complications have been shown to have a significant impact on shoulder-specific outcome. Little is known to date about an influence on injury-independent quality of life.
The aim of this retrospective study is to analyse whether patients with a poor functional outcome after surgically treated proximal humerus fracture also show a reduced general quality of life in the medium term. Emphasis is placed on the analysis of patients with poor functional outcome due to postsurgical complications.
Evaluation of all patients operated at one level 1 trauma centre with a proximal humerus fracture in the period 01.01.2005 to 31.12.2015 and follow-up using validated scores (Constant-Murley Score [CMS], EQ-5D). Two groups, group A with good outcome (∆CMS ≤ 15P.) and group B with poor outcome (∆CMS ≥ 16P.), were defined. Furthermore, descriptive variables including definition of a complication were defined in advance.
138 patients were included in the study (group A: 91, group B: 47). The mean follow-up was 93.86 months ± 37.33 (36-167). Group B had significantly more complications. Furthermore, patients with poor outcome regarding the shoulder (group B) were also found to have significantly lower EQ-VAS (78.9 ± 19.2 [20.0-100] vs. 70.4 ± 19.5 [15.0-98.0]; p = 0.008) and EQ index (0.91 ± 0.14 [0.19-1.00] vs. 0.82 ± 0.17 [0.18-1.00]; p < 0.001).
In conclusion, in the present study, the patients with poor outcome of shoulder function in CMS have significantly lower overall quality of life after a mean of more than 6 years of follow-up. The poor outcome was due to a significantly higher postoperative complication rate. This was independent of the fracture morphology present and the surgical procedure used.
肱骨近端骨折的手术治疗是一种已确立的方法。术后并发症已被证明对肩部特定结局有重大影响。迄今为止，关于对独立于损伤的生活质量的影响知之甚少。
本回顾性研究的目的是分析接受肱骨近端骨折手术后功能结果不佳的患者在中期是否也表现出一般生活质量降低。重点分析因术后并发症导致功能结果不佳的患者。
评估 2005 年 1 月 1 日至 2015 年 12 月 31 日在一家 1 级创伤中心接受肱骨近端骨折手术的所有患者，并使用经过验证的评分（Constant-Murley 评分[CMS]、EQ-5D）进行随访。定义了两组，功能结果良好的组 A（∆CMS≤15P.）和功能结果不佳的组 B（∆CMS≥16P.）。此外，还预先定义了包括并发症定义在内的描述性变量。
本研究共纳入 138 例患者（组 A：91 例，组 B：47 例）。平均随访时间为 93.86 个月±37.33（36-167）。组 B 的并发症明显更多。此外，肩部功能结果不佳的患者（组 B）的 EQ-VAS 也明显较低（78.9±19.2[20.0-100] vs. 70.4±19.5[15.0-98.0]；p=0.008）和 EQ 指数（0.91±0.14[0.19-1.00] vs. 0.82±0.17[0.18-1.00]；p<0.001）。
总之，在本研究中，CMS 肩部功能结果不佳的患者在平均 6 年多的随访后，整体生活质量明显较低。不良预后归因于术后并发症发生率显著升高。这与骨折形态和所使用的手术过程无关。
