《移位肱骨干骨折：手术与非手术治疗的比较》

The Translated Proximal Humerus Fracture: A Comparison of Operative and Nonoperative Management.

机构信息

Department of Orthopaedic Surgery, The Alfred, Melbourne, Australia.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

出版信息

J Orthop Trauma. 2023 Sep 1;37(9):e341-e348. doi: 10.1097/BOT.0000000000002612.

DOI:10.1097/BOT.0000000000002612

PMID:37053113

Abstract

OBJECTIVES

To report on the long-term outcomes of the management of translated proximal humerus fractures.

DESIGN

A prospective cohort study was conducted from January 2010 to December 2018.

SETTING

Academic Level 1 trauma center.

PARTICIPANTS/PATIENTS: A total of 108 patients with a proximal humerus fracture with ≥100% translation, defined as no cortical bony contact between the shaft and humeral head fragments, were included.

INTERVENTION

Patients were managed nonoperatively with sling immobilization or with operative management as determined by the treating surgeon.

MAIN OUTCOME MEASURES

Outcome measures were the Oxford Shoulder Score, EQ-5D-5L, return to work, and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, nonunion/malunion, and avascular necrosis.

RESULTS

Of the 108 patients, 76 underwent operative intervention and 32 were managed nonoperatively. The mean (SD) age in the operative group was 54.3 (±20.2) years and in the nonoperative group was 73.3 (±15.3) years ( P < 0.001). There was no association between Oxford Shoulder Score and management options (mean 38.5 [±9.5] operative versus mean 41.3 [±8.5] nonoperative, P = 0.48). Operative management was associated with improved health status outcomes; EQ-5D utility score adjusted mean difference was 0.16 (95% CI, 0.04-0.27; P = 0.008); EQ-5D VAS adjusted mean difference was 19.2 (95% CI, 5.2-33.2; P = 0.008). Operative management was associated with a lower odds of nonunion (adjusted OR 0.30; 95% CI, 0.09-0.97; P = 0.04), malunion (adjusted OR 0.14; 95% CI, 0.04-0.51; P = 0.003), and complications (adjusted OR 0.07; 95% CI, 0.02-0.32; P = 0.001).

CONCLUSION

Translated proximal humerus fractures with ≥100% displacement demonstrate improved health status and radiological outcomes after surgical fixation.

LEVEL OF EVIDENCE

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

摘要

目的

报告翻译近端肱骨骨折的长期治疗结果。

设计

前瞻性队列研究，2010 年 1 月至 2018 年 12 月进行。

地点

学术一级创伤中心。

参与者/患者：纳入了 108 例肱骨近端骨折患者，其肱骨近端骨折伴有≥100%的移位，定义为骨干和肱骨头碎片之间没有皮质骨接触。

干预

根据治疗医生的决定，患者采用吊带固定进行非手术治疗或手术治疗。

主要观察指标

牛津肩部评分、EQ-5D-5L、重返工作岗位和影像学结果。记录的并发症包括进一步手术、位置/固定丢失、骨不连/畸形愈合和缺血性坏死。

结果

108 例患者中，76 例行手术干预，32 例行非手术治疗。手术组的平均（SD）年龄为 54.3（±20.2）岁，非手术组为 73.3（±15.3）岁（P<0.001）。牛津肩部评分与治疗方法之间无相关性（手术组平均 38.5[±9.5]，非手术组平均 41.3[±8.5]，P=0.48）。手术治疗与健康状况改善相关；EQ-5D 效用评分调整平均差异为 0.16（95%可信区间，0.04-0.27；P=0.008）；EQ-5D VAS 调整平均差异为 19.2（95%可信区间，5.2-33.2；P=0.008）。手术治疗与非骨不连（调整比值比 0.30；95%可信区间，0.09-0.97；P=0.04）、畸形愈合（调整比值比 0.14；95%可信区间，0.04-0.51；P=0.003）和并发症（调整比值比 0.07；95%可信区间，0.02-0.32；P=0.001）的发生率较低相关。