Lee Chul Hyung, Kim Seo Yul
Department of Orthopedics, Daejeon Sun Hospital, 29 Mok-Dong, Jung-gu, Daejeon, 34811, South Korea.
Eur J Orthop Surg Traumatol. 2023 Dec;33(8):3461-3467. doi: 10.1007/s00590-023-03569-z. Epub 2023 May 16.
This study shows the effectiveness of locking compression plate for proximal humeral fractures in elderly patients over 80 years old without structural bone grafting compared age group of 65-79 (Group 1) with 80 and above (Group 2).
This study included sixty-one patients who underwent using locking compression plate for proximal humeral fractures between April 2016 and November 2021. The patients were divided into two groups. The neck shaft angle (NSA) was checked at immediately after surgery, at 1 month and the final follow-up visit. The NSA changes in the two groups were compared using the independent t-test. In addition, multiple regression analysis was used to find out which factors affect NSA changes.
In group 1, the mean difference between NSA immediately after surgery and 1 month after surgery was 2.74°, and group 2 was 2.89°. In group 1, the mean difference in NSA for 1 month after surgery and at the last follow-up was 1.43°, and group 2 was 1.75°. No significant difference was observed in the NSA changes between two groups (p = 0.59, 0.173). Bone marrow density and four-part fracture type were significant difference in NSA changes (p = 0.003, 0.035). The disabilities of the arm, shoulder and hand scale (DASH scale), age, medical support, diabetes and three-part fracture type were no significant in NSA changes.
Using locking compression plate without structural bone grafting is a good option in elderly patients over 80 years old and can help achieve radiological results similar to patients which age group of 67-79.
本研究展示了锁定加压钢板治疗80岁以上老年肱骨近端骨折且不进行结构性植骨的有效性,并比较了65 - 79岁年龄组(第1组)和80岁及以上年龄组(第2组)的情况。
本研究纳入了2016年4月至2021年11月间接受锁定加压钢板治疗肱骨近端骨折的61例患者。患者被分为两组。术后即刻、术后1个月及末次随访时检查颈干角(NSA)。两组NSA的变化采用独立t检验进行比较。此外,采用多元回归分析来找出影响NSA变化的因素。
在第1组中,术后即刻与术后1个月NSA的平均差值为2.74°,第2组为2.89°。在第1组中,术后1个月与末次随访时NSA的平均差值为1.43°,第2组为1.75°。两组间NSA变化无显著差异(p = 0.59,0.173)。骨髓密度和四部分骨折类型在NSA变化方面有显著差异(p = 0.003,0.035)。上肢、肩部和手部功能障碍量表(DASH量表)、年龄、医疗支持、糖尿病和三部分骨折类型在NSA变化方面无显著差异。
对于80岁以上老年患者,不进行结构性植骨使用锁定加压钢板是一个不错的选择,并且能帮助获得与67 - 79岁年龄组患者相似的影像学结果。