Medical School of Southeast University, Nanjing, Jiangsu, PR China. Dr. Cui is now with the Department of Orthopaedics, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, PR China.
Department of Orthopaedics, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, PR China.
J Orthop Trauma. 2022 Sep 1;36(9):445. doi: 10.1097/BOT.0000000000002357. Epub 2022 Mar 2.
To compare the clinical and radiological results of locking plate fixation with and without spine cage for the treatment of unstable proximal humeral fractures in elderly patients.
Retrospective study.
Level 1 Trauma Center.
PATIENTS/PARTICIPANTS: A total of 62 patients with a mean age of 72.68 (60-88) years were included. Thirty-nine patients were treated with only a locking compression plate (LCP group), whereas 23 patients were treated with a locking compression plate and a spine cage (SC group). The mean follow-up was 32.26 (24-46) months.
Radiological outcomes were assessed using the humeral head height and neck-shaft angle. The clinical results were evaluated using a visual analog scale for pain, the Constant-Murley score, the American Shoulder and Elbow score, and shoulder range of motion.
The average radiological changes in the humeral head height and neck-shaft angle were significantly higher in the LCP group than in the SC group ( P < 0.001 and P < 0.001, respectively). The final outcome scores were lower in the LCP group than in the SC group (Constant-Murley score of 73.26 vs. 78.91 [ P = 0.028] and American Shoulder and Elbow score of 72.36 vs. 78.57 [ P = 0.011]). The SC group showed better forward elevation ( P = 0.005) and abduction ( P = 0.001); however, no significant differences were observed for shoulder external or internal rotation. The number of complications was higher in the LCP group (38.5%) than in the SC group (13.0%) ( P = 0.033).
For unstable proximal humeral fractures with medial comminution in elderly patients, locking plate with an SC is a reasonable option to ensure satisfactory results and lower the postoperative complications.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较带或不带脊柱 cage 的锁定钢板固定治疗老年不稳定型肱骨近端骨折的临床和影像学结果。
回顾性研究。
1 级创伤中心。
患者/参与者：共纳入 62 例患者，平均年龄 72.68（60-88）岁。39 例仅行锁定加压钢板（LCP 组）治疗，23 例行锁定加压钢板加脊柱 cage（SC 组）治疗。平均随访 32.26（24-46）个月。
采用肱骨头高度和颈干角评估影像学结果。采用视觉模拟评分法评估疼痛、Constant-Murley 评分、美国肩肘外科评分和肩关节活动范围评估临床结果。
LCP 组肱骨头高度和颈干角的平均影像学变化明显高于 SC 组（P<0.001 和 P<0.001）。LCP 组的最终结局评分明显低于 SC 组（Constant-Murley 评分 73.26 分比 78.91 分，P=0.028；美国肩肘外科评分 72.36 分比 78.57 分，P=0.011）。SC 组前屈（P=0.005）和外展（P=0.001）角度更好；但肩外旋和内旋角度无显著差异。LCP 组并发症发生率（38.5%）高于 SC 组（13.0%）（P=0.033）。
对于伴有内侧粉碎的老年不稳定型肱骨近端骨折，带 SC 的锁定钢板是一种确保满意结果和降低术后并发症的合理选择。
治疗性 III 级。有关证据水平的完整说明，请参阅作者指南。
