Thelen Simon, Grassmann Jan P, Schneider Madeleine, Jaekel Carina, Meier Dana M, Betsch Marcel, Hakimi Mohssen, Wild Michael
Department of Orthopedics and Trauma Surgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Department of Orthopedics, Trauma and Hand Surgery, Klinikum Darmstadt, Darmstadt, Germany.
GMS Interdiscip Plast Reconstr Surg DGPW. 2022 May 23;11:Doc03. doi: 10.3205/iprs000164. eCollection 2022.
For proximal humeral fractures open reduction und internal fixation (ORIF) with a fixed-angle plate is considered the gold standard for surgical management. However, it can lead to poor functional outcomes and is associated with postoperative complications. Therefore, the purpose of this study was to investigate the influence of fracture severity by applying a new classification (simple versus complex) on clinical outcome and quality of life after ORIF of proximal humerus fractures.
We conducted a prospective clinical study with an average follow-up period of 12 (SD 1) months after ORIF of proximal humeral fractures with a fixed-angle plate. The postoperative function and quality of life was measured using the Oxford Shoulder Score (OSS) and the Constant Score. Data was tested for statistical significance with the Mann-Whitney test and Fisher's exact test. Based on the findings of this study a simplified fracture classification system has been developed.
Seventy-two patients with a mean age of 65 years (SD 12) with 69% being males were included. According to the Neer classification, 35% (n=25) non-displaced ("one-part fractures"), 19% (n=14) two-part fractures, 15% (n=11) three-part fractures and 31% (n=22) four-part fractures were detected. Regarding the AO/OTA classification, 18% (n=13) were type A fractures, 43% (n=31) type B and 39% (n=28) type C fractures. From these criteria we derived our own fracture classification, including 50% (n=36) simple and 50% (n=36) severe fractures. Patients with simple fracture types achieved significantly higher total values in the Constant Score as well as the OSS (p=0.008; p=0.013). The cumulative incidence of complications in the entire patient collective was 14% (n=10) with humeral head necrosis (n=5) occurring only in the severe fracture group.
The postoperative clinical outcome as well as the incidence of humeral head necrosis after ORIF of proximal humeral fractures with a fixed-angle plate correlates with the fracture type and severity. The newly derived fracture classification into simple and severe fractures is suitable with regard to clinical results and complication rate. However, prospective studies comparing ORIF vs. conservative treatment of proximal humeral fractures of the same severity are required.
III.
对于肱骨近端骨折，采用角钢板切开复位内固定术（ORIF）被认为是手术治疗的金标准。然而，它可能导致功能预后不佳，并伴有术后并发症。因此，本研究的目的是通过应用一种新的分类方法（简单型与复杂型）来探讨骨折严重程度对肱骨近端骨折ORIF术后临床疗效和生活质量的影响。
我们进行了一项前瞻性临床研究，对采用角钢板进行肱骨近端骨折ORIF术后的患者进行平均12（标准差1）个月的随访。使用牛津肩部评分（OSS）和Constant评分来测量术后功能和生活质量。数据采用曼-惠特尼检验和费舍尔精确检验进行统计学显著性检验。基于本研究的结果，开发了一种简化的骨折分类系统。
纳入72例平均年龄65岁（标准差12）的患者，其中69%为男性。根据Neer分类，发现35%（n = 25）为无移位骨折（“一部分骨折”），19%（n = 14）为两部分骨折，15%（n = 11）为三部分骨折，31%（n = 22）为四部分骨折。根据AO/OTA分类，18%（n = 13）为A型骨折，43%（n = 31）为B型骨折，39%（n = 28）为C型骨折。根据这些标准，我们得出了自己的骨折分类，包括50%（n = 36）的简单骨折和50%（n = 36）的严重骨折。简单骨折类型的患者在Constant评分和OSS中的总分显著更高（p = 0.008；p = 0.013）。整个患者群体的并发症累积发生率为14%（n = 10），肱骨头坏死（n = 5）仅发生在严重骨折组。
采用角钢板进行肱骨近端骨折ORIF术后的临床疗效以及肱骨头坏死的发生率与骨折类型和严重程度相关。新得出的简单骨折和严重骨折分类在临床结果和并发症发生率方面是合适的。然而，需要进行前瞻性研究来比较相同严重程度的肱骨近端骨折ORIF与保守治疗的效果。
III级
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