Department of Traumatic Osteopathy Surgery, the Affiliated Hospital of Qinghai University, Xining, China.
Department of Traumatic Osteopathy Surgery, Golmud People's Hospital, Haixi, China.
Ann Palliat Med. 2022 Mar;11(3):1077-1084. doi: 10.21037/apm-22-195.
The three- and four-part fractures of the proximal humerus are often combined with rotator cuff injury, and shoulder joint replacement is often selected clinically. The concept of "shoulder preservation" can greatly restore the function of the shoulder joint through internal fixation of the proximal humerus fracture and rotator cuff suture. This study investigated the clinical effect of the concept of "shoulder preservation" in the treatment of three- and four-part fractures of the proximal humerus.
We conducted a retrospective analysis of 66 patients with proximal humeral fractures (PHFs) who were treated at the Affiliated Hospital of Qinghai University between 2016 and 2019. The patients were divided into 3 groups according to the Neer fracture classification system, and the fracture healing time of the 3 groups was compared. A visual analog scale (VAS) was used to evaluate the pain, and the Neer score was used to evaluate shoulder joint function.
The operations were successfully completed and the 3 groups of patients were compared in pairs. All incisions healed by first intention after operation, and no early complications occurred. The average follow-up time was 18 months. All fractures had healed. The VAS score of the 3 groups of patients was 1.5±0.5 at 1 month after operation and 1.0±0.5 at the final follow-up, which was significantly improved compared with preoperative scores, although the difference was not statistically significant (P>0.05). The Neer scores of the first group of patients at 1, 3, and 9 months postsurgery were higher than those of the second and third groups, and the difference was statistically significant (P<0.05). There was no significant difference among the 3 groups in Neer score 12 months after the operation (P>0.05).
Proximal humeral internal locking osteosynthesis system (PHILOS) fixation + rotator cuff suture is a reliable treatment method involving a simple operation, firm fixation, and good postoperative recovery. It can restore shoulder joint function to the greatest extent, but it also has some shortcomings, including slow recovery time.
肱骨近端三部分和四部分骨折常合并肩袖损伤，临床上常选择肩关节置换。“保留肩部”的概念通过肱骨近端骨折的内固定和肩袖缝合可以极大地恢复肩关节功能。本研究探讨了“保留肩部”概念治疗肱骨近端三部分和四部分骨折的临床效果。
回顾性分析 2016 年至 2019 年青海大学附属医院收治的 66 例肱骨近端骨折（PHF）患者，根据 Neer 骨折分型系统将患者分为 3 组，比较 3 组骨折愈合时间。采用视觉模拟评分（VAS）评估疼痛，采用 Neer 评分评估肩关节功能。
手术均顺利完成，3 组患者两两比较。术后所有切口均一期愈合，无早期并发症发生。平均随访时间 18 个月。所有骨折均愈合。3 组患者术后 1 个月 VAS 评分为 1.5±0.5，末次随访时为 1.0±0.5，与术前比较均明显改善，但差异无统计学意义（P>0.05）。术后 1、3、9 个月，第 1 组患者的 Neer 评分均高于第 2、3 组，差异有统计学意义（P<0.05）。术后 12 个月 3 组患者的 Neer 评分差异无统计学意义（P>0.05）。
肱骨近端锁定接骨板系统（PHILOS）固定+肩袖缝合是一种可靠的治疗方法，具有手术操作简单、固定牢固、术后恢复良好的优点。它可以最大限度地恢复肩关节功能，但也存在一些缺点，包括恢复时间较慢。
