Oldrini Lorenzo Massimo, Feltri Pietro, Albanese Jacopo, Marbach Francesco, Filardo Giuseppe, Candrian Christian
Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland.
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Via Buffi 13, 6900 Lugano, Switzerland.
Life (Basel). 2022 Feb 19;12(2):311. doi: 10.3390/life12020311.
The aim of this study was to quantify the rate of complications and reinterventions in patients treated with PHILOS plate for proximal humerus fractures (PHFs) synthesis.
A comprehensive literature search was performed on the PubMed, Web of Science, Embase, and Cochrane databases up to 7 October 2021. Studies describing medium and long-term complications in PHF synthesis using the PHILOS plate were included. A systematic review and meta-analysis were performed on complications and causes of reinterventions. Assessment of risk of bias and quality of evidence was performed with the Downs and Black's "Checklist for Measuring Quality".
Seventy-six studies including 4200 patients met the inclusion criteria. The complication rate was 23.8%, and the main cause was screw cut-out (4.1%), followed by avascular necrosis (AVN) (3.1%) and subacromial impingement (1.5%). In patients over 55 years, the complication rate was 29.5%. In the deltopectoral (DP) approach the complication rate was 23.8%, and in the delto-split (DS) it was 17.5%, but no difference between the two approaches was seen when considering the type of fracture. The overall reintervention rate was 10.5% in the overall population and 19.0% in older patients.
Proximal humerus synthesis with a PHILOS plate has high complications and reintervention rates. The most frequent complication was screw cut-out, followed by humeral head AVN and subacromial impingement. These results need to be further investigated to better understand both the type of patient and fracture that is more at risk of complications and reintervention and to compare pros and cons of the PHILOS plate with respect to the other solutions to manage PHFs.
本研究旨在量化使用PHILOS钢板治疗肱骨近端骨折（PHF）患者的并发症发生率和再次干预率。
截至2021年10月7日，在PubMed、科学网、Embase和Cochrane数据库上进行了全面的文献检索。纳入描述使用PHILOS钢板进行PHF内固定的中长期并发症的研究。对并发症和再次干预的原因进行了系统评价和荟萃分析。采用唐斯和布莱克的“质量测量清单”对偏倚风险和证据质量进行评估。
76项研究（包括4200例患者）符合纳入标准。并发症发生率为23.8%，主要原因是螺钉穿出（4.1%），其次是缺血性坏死（AVN）（3.1%）和肩峰下撞击（1.5%）。55岁以上患者的并发症发生率为29.5%。采用三角肌胸大肌（DP）入路时并发症发生率为23.8%，采用三角肌劈开（DS）入路时为17.5%，但考虑骨折类型时两种入路之间未见差异。总体人群的再次干预率为10.5%，老年患者为19.0%。
使用PHILOS钢板进行肱骨近端内固定的并发症和再次干预率较高。最常见的并发症是螺钉穿出，其次是肱骨头AVN和肩峰下撞击。需要进一步研究这些结果，以更好地了解更易发生并发症和再次干预的患者类型和骨折类型，并比较PHILOS钢板与其他治疗PHF方法的优缺点。
