Neudeck Rouven, Daferner Mark Philipp, Fleischhacker Evi, Helfen Tobias, Gilbert Fabian, Böcker Wolfgang, Ockert Ben, Siebenbürger Georg
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Marchioninistr. 15, Munich 81377, Germany.
Augenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe 76133, Germany.
Injury. 2023 Mar 29. doi: 10.1016/j.injury.2023.03.033.
The best surgical management of displaced proximal humeral fractures remains a matter of considerable debate. This study presents mid-term functional outcome (median 4 years) after locking plate osteosynthesis for displaced proximal humeral fractures.
Between February 2002 and December 2014 1031 patients with 1047 displaced proximal humeral fractures were treated by open reduction and locking plate fixation with the same implant and received consecutive prospective follow up at least 24 months after surgical treatment. Clinical follow-up consisted of Constant Murley score (CS), Disabilities of the Arm, Shoulder and Hand score (DASH), and Short Form 36 questionnaire (SF-36). Complete follow-up could be performed in 557 (53.2%) cases, with a mean follow-up of 4.0 ± 2.7 years.
Of 557 patients (67% women; mean age at time of osteosynthesis: 68.3 ± 15.5 years) absolute CS of all patients 4 ± 2.7 years after surgery was 68.4 ± 20.3 points. Normalized CS according to Katolik was 80.4 ± 23.8 points, and CS in percentage to the contralateral side (%CS) was 87.2 ± 27.9%. DASH score was at 23.8 ± 20.8 points. Osteosynthesis related complications (secondary displacement, screw cutout, avascular necrosis (n = 117 patients) were associated with lower functional scores (mean CS was 54.5 ± 19.0 p.; nCS 64.5 ± 22.9 p.;%CS 71.2 ± 25.0%; DASH score 31.9 ± 22.4 p.). The SF 36 was 66.5 points in the case cohort and a vitality mean of 69.4 points. Patients with a complication showed lower results (SF 36 56.7; vitality mean 64.9 points).
Overall, patients following locking plate osteosynthesis of displaced proximal humeral fractures showed good to moderate outcomes four years after surgery. Mid-term functional outcomes correlate significantly with those at 1 year postoperatively. Furthermore, there is a significant negative correlation of midterm functional outcome with the occurrence of complications.
Level III, prospective nonconsecutive patients.
肱骨近端移位骨折的最佳手术治疗方法仍存在很大争议。本研究介绍了采用锁定钢板内固定治疗肱骨近端移位骨折的中期功能结果（中位时间4年）。
2002年2月至2014年12月期间，1031例患有1047处肱骨近端移位骨折的患者接受了切开复位及使用同一植入物的锁定钢板固定治疗，并在手术治疗后至少连续随访24个月。临床随访包括Constant Murley评分（CS）、上肢、肩部和手部功能障碍评分（DASH）以及简明健康调查问卷（SF-36）。557例（53.2%）患者获得了完整随访，平均随访时间为4.0±2.7年。
557例患者（67%为女性；内固定时平均年龄：68.3±15.5岁）术后4±2.7年的绝对CS评分为68.4±20.3分。根据卡托利克法标准化后的CS评分为80.4±23.8分，与对侧相比的CS百分比（%CS）为87.2±27.9%。DASH评分为23.8±20.8分。内固定相关并发症（二次移位、螺钉穿出、缺血性坏死（n = 117例患者））与较低的功能评分相关（平均CS评分为54.5±19.0分；标准化CS评分为64.5±22.9分；%CS评分为71.2±25.0%；DASH评分为31.9±22.4分）。病例队列的SF-36评分为66.5分，活力平均评分为69.4分。出现并发症的患者结果较低（SF-36评分为56.7分；活力平均评分为64.9分）。
总体而言，肱骨近端移位骨折患者行锁定钢板内固定术后四年显示出良好至中等的结果。中期功能结果与术后1年的结果显著相关。此外，中期功能结果与并发症的发生存在显著负相关。
III级，前瞻性非连续性患者。
