与非手术治疗相比，采用锁定钢板固定治疗成人肱骨近端骨折的早期结果：年龄、合并症和骨折形态匹配分析。

Early Outcomes of Proximal Humerus Fractures in Adults Treated With Locked Plate Fixation Compared with Nonoperative Treatment: An Age-, Comorbidity-, and Fracture Morphology-Matched Analysis.

机构信息

Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY; and.

Department of Orthopaedics, University of California Davis, Sacramento, CA.

出版信息

J Orthop Trauma. 2023 Mar 1;37(3):142-148. doi: 10.1097/BOT.0000000000002511.

DOI:10.1097/BOT.0000000000002511

PMID:36730947

Abstract

OBJECTIVES

To compare patient-reported outcomes (PROs), range of motion (ROM), and complication rates for proximal humerus fractures managed nonoperatively or with open reduction internal fixation (ORIF).

DESIGN

Retrospective cohort.

SETTING

Academic level 1 trauma center.

PATIENTS/PARTICIPANTS: Four hundred thirty-one patients older than 55 years were identified retrospectively. 122 patients were excluded. 309 patients with proximal humerus fractures met inclusion criteria (234 nonoperative and 75 ORIF). After matching, 192 patients (121 nonoperative and 71 ORIF) were included in the analysis.

INTERVENTION

Nonoperative versus ORIF (locked plate) treatment of proximal humerus fracture.

MAIN OUTCOME MEASUREMENTS

Early Visual Analog Score (VAS), ROM, PROs, complications, and reoperation rates between groups.

RESULTS

At 2 weeks, ORIF showed lower VAS scores, better passive ROM, and patient-reported outcomes measurement information system (PROMIS) scores ( P < 0.05) compared with nonoperative treatment. At 6 weeks, open reduction internal fixation (ORIF) had lower VAS scores, better passive ROM, and PROMIS scores ( P < 0.05) compared with nonoperative treatment. At 3 months, ORIF showed similar PROMIS scores ( P > 0.05) but lower VAS scores and better passive ROM ( P < 0.05) compared with nonoperative treatment. At 6 months, ORIF showed similar VAS scores, ROM, and PROMIS scores ( P > 0.05) compared with nonoperative treatment. There was no difference in secondary operation rates between groups ( P > 0.05). ORIF patients trended toward a higher secondary reoperation rate (15.5% vs. 5.0%) than nonoperative patients ( P = 0.053).

CONCLUSIONS

In an age-, comorbidity-, and fracture morphology-matched analysis of proximal humerus fractures, ORIF led to decreased pain and improved passive ROM early in recovery curve compared with nonoperative treatment that normalized after 6 months between groups.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

比较非手术治疗和切开复位内固定（ORIF）治疗肱骨近端骨折的患者报告结局（PROs）、活动范围（ROM）和并发症发生率。

设计

回顾性队列研究。

地点

学术水平 1 级创伤中心。

患者/参与者：回顾性确定了 431 名年龄大于 55 岁的患者。排除了 122 名患者。符合肱骨近端骨折纳入标准的 309 名患者（234 例非手术治疗和 75 例 ORIF）。匹配后，192 名患者（121 例非手术治疗和 71 例 ORIF）纳入分析。

干预措施

非手术治疗与 ORIF（锁定钢板）治疗肱骨近端骨折。

主要观察指标

两组间早期视觉模拟评分（VAS）、ROM、PROs、并发症和再次手术率。

结果

在 2 周时，与非手术治疗相比，ORIF 显示较低的 VAS 评分、更好的被动 ROM 和患者报告的测量信息系统（PROMIS）评分（P<0.05）。在 6 周时，与非手术治疗相比，ORIF 具有较低的 VAS 评分、更好的被动 ROM 和 PROMIS 评分（P<0.05）。在 3 个月时，与非手术治疗相比，ORIF 显示出相似的 PROMIS 评分（P>0.05），但 VAS 评分和被动 ROM 更好（P<0.05）。在 6 个月时，与非手术治疗相比，ORIF 显示出相似的 VAS 评分、ROM 和 PROMIS 评分（P>0.05）。两组间二次手术率无差异（P>0.05）。ORIF 患者的二次再手术率（15.5%比 5.0%）高于非手术患者（P=0.053）。