Gomes Gustavo Remigio, Maciel Rafael Almeida, Almeida Neto José Inácio DE, Toledo Daniel Carvalho DE, Machado Carla Jorge, Bomfim Leonidas DE Souza
Hospital de Base do Distrito Federal, Shoulder and Elbow Service, Brasília, DF, Brazil.
Universidade Federal de Minas Gerais, Medical School, Department of Preventive and Social Medicine, Belo Horizonte, MG, Brazil.
Acta Ortop Bras. 2022 Nov 11;30(5):e256113. doi: 10.1590/1413-785220223005e256113. eCollection 2022.
To evaluate and compare the proportions of complications and radiographic findings of osteosynthesis of 2- and 3-part proximal humerus fractures with two methods of treatment: third-generation antegrade nailing and locking plate.
46 patients with a mean age of 58.9 ± 16.6 years between January 2020 and January 2021 were evaluated. In sixteen cases (34.8%), antegrade nailing was used, and in thirty cases (65, 2%), a locking proximal humerus plate. The method used included the rate of complications with a minimum follow-up of 6 months after surgery and radiographic evaluation.
There was no difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p = 0.681). The nail group had less residual varus loss (cervicodiaphyseal angle nail group with 132.1º ± 2.3º, plate group 123.8º ± 10.1º; p < 0.001). In the plate group, women had the lowest value (1.43 ± 0.22) of the deltoid tuberosity index (DTI) compared to men (1.58 ± 0.11) (p = 0.022).
Osteosynthesis, with a locking plate and antegrade nailing, did not show differences in the proportion of complications. The nail group had less change in the postoperative cervicodiaphyseal angle, however, there were two serious complications with screw cut-out and varus deviation, requiring surgical reapproach.
采用两种治疗方法，即第三代顺行髓内钉和锁定钢板，评估和比较两部分及三部分肱骨近端骨折骨接合术的并发症比例和影像学表现。
对2020年1月至2021年1月期间平均年龄为58.9±16.6岁的46例患者进行评估。16例（34.8%）采用顺行髓内钉治疗，30例（65.2%）采用肱骨近端锁定钢板治疗。所采用的方法包括术后至少6个月的并发症发生率及影像学评估。
两组间并发症比例无差异（髓内钉组18.8%，钢板组(13.3%)；(p = 0.681)）。髓内钉组的残余内翻丢失较少（髓内钉组的颈干角为(132.1^{\circ}\pm2.3^{\circ})，钢板组为(123.8^{\circ}\pm10.1^{\circ})；(p < 0.001)）。在钢板组中，女性的三角肌粗隆指数（DTI）值（(1.43\pm0.22)）低于男性（(1.58\pm0.11)）（(p = 0.022)）。
锁定钢板和顺行髓内钉骨接合术在并发症比例上无差异。髓内钉组术后颈干角变化较小，然而，有两例出现螺钉穿出和内翻畸形等严重并发症，需要再次手术。
