Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P.R. China.
Orthop Surg. 2022 Sep;14(9):2109-2118. doi: 10.1111/os.13421. Epub 2022 Aug 4.
The purpose of this study was to evaluate the best placement of calcar screws in proximal humerus fracture surgeries.
This retrospective cohort study included clinical and radiographic outcomes of 98 patients treated with proximal humerus fracture surgeries between January 2017 and June 2020. Demographic data of patients were obtained from medical records. The surgical and radiographic results were also collected: operation time, blood loss, time to surgery, fibular allograft, disruption of medial region hinge, Neer classification, and recovery of medial support. Patients were allocated into two groups: the locking plate group (n = 65) and the intramedullary nail group (n = 33). In this study, we proposed new predictive indicators, named horizontal ratio (HR) and vertical ratio (VR), to quantify the placement of calcar screws in these two groups. A receiver operating characteristic (ROC) analysis was conducted to display the accuracy of these indicators. Shoulder activity, visual scale analog (VAS) score, and Constant score were performed to evaluate postoperative clinical outcomes at 1 year follow-up.
In the multivariate logistic regression analysis, only time to surgery and effective medial support were considered statistically significant factors of postoperative complications (p < 0.05). Significant differences were observed between medial support and postoperative complications both in the locking plate group and the intramedullary nail group (p < 0.05). Only the vertical ratio of locking plate (VRLP) was a statistically significant predictor of postoperative complications (p < 0.05). The area under curve was calculated to assess the predictive value of VRLP, which came to 0.84. In addition, a ROC analysis found quantifiable thresholds of the VR was 0.1713 as measures to avoid postoperative complications in the locking plate fixation.
In locking plate fixation, the incidence of postoperative complications increased significantly when the VR of calcar screws greater than 0.1713, which was beneficial to surgeons to place calcar screws.
本研究旨在评估肱骨近端骨折手术中置钉的最佳位置。
这是一项回顾性队列研究，纳入了 2017 年 1 月至 2020 年 6 月期间接受肱骨近端骨折手术的 98 例患者的临床和影像学结果。从病历中获取患者的人口统计学数据。还收集了手术和影像学结果：手术时间、失血量、手术时间、腓骨同种异体移植、内侧区域铰链中断、Neer 分类和内侧支撑恢复。患者被分为两组：锁定钢板组（n=65）和髓内钉组（n=33）。在本研究中，我们提出了新的预测指标，命名为水平比（HR）和垂直比（VR），以量化这两组中置钉的位置。进行了接收者操作特征（ROC）分析以显示这些指标的准确性。在 1 年随访时进行了肩部活动度、视觉模拟量表（VAS）评分和 Constant 评分，以评估术后临床结果。
在多变量逻辑回归分析中，只有手术时间和有效内侧支撑被认为是术后并发症的统计学显著因素（p<0.05）。在锁定钢板组和髓内钉组中，内侧支撑和术后并发症之间均存在显著差异（p<0.05）。只有锁定钢板的垂直比（VRLP）是术后并发症的统计学显著预测因子（p<0.05）。计算曲线下面积以评估 VRLP 的预测价值，结果为 0.84。此外，ROC 分析发现 VR 的定量阈值为 0.1713，可作为避免锁定钢板固定术后并发症的措施。
在锁定钢板固定中，当 calcar 螺钉的 VR 大于 0.1713 时，术后并发症的发生率显著增加，这有利于外科医生置钉。
