Sheng Ning, Wang Qiuke, Xing Fei, Wang Jie, Chen Yunfeng, Xiang Zhou
Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Lane 37, Chengdu, 610041, Sichuan Province, China.
Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200235, China.
Injury. 2023 Aug;54(8):110861. doi: 10.1016/j.injury.2023.110861. Epub 2023 Jun 3.
Displaced proximal humeral fractures (PHF) are frequently treated with locking plates to achieve osteosynthesis. Bone grafts are used as augmentation techniques to improve stability in osteoporotic patients. However, there has been little research into whether bone grafts are necessary for patients younger than 65 years old. This study compared radiographic and clinical outcomes between PHFs augmented with bone grafts or not in a younger population.
Between January 2016 and June 2020, 91 patients treated with a locking plate alone (LP), and 101 patients treated with locking plates augmented with bone grafts (BG) were analyzed. Potential confounding factors for outcomes were adjusted by propensity score-matching analyses. For the retrospective cohort study, 62 patients from each group were evaluated for radiographic outcomes and clinical outcomes and compared.
Sixth-two patients in each group, both with a mean age of 52 years old, were with a mean follow-up time of 25 months in the LP group and 26 months in the BG group. There was no difference in demographic or surgical characteristics between the two groups after propensity score-matching. With regard to radiographic outcomes, the changes in neck-shaft angle (-5.1 ± 4.9 vs. -3.1 ± 5.3, p = 0.015) and humeral head height (-1.5 ± 2.5 vs. -0.4 ± 2.7, p = 0.002) were more obvious in the BG group. However, regarding functional outcomes, there were no significant differences between the two groups in DASH score, Constant-Murley score, or VAS score. Moreover, the complication rate was not significantly different between two groups.
Allografts only provide minor improvements of stability in radiography for patients less than 65 years old after locking plate fixation of PHFs, but don't improve shoulder function, relieve pain or reduce complications. We concluded that allografts are unnecessary for younger patients with displaced PHFs.
移位的肱骨近端骨折（PHF）常采用锁定钢板进行骨固定。骨移植作为一种增强技术，用于改善骨质疏松患者的稳定性。然而，对于65岁以下的患者是否需要骨移植，目前研究较少。本研究比较了年轻人群中接受或未接受骨移植的PHF患者的影像学和临床结果。
分析2016年1月至2020年6月期间，91例仅接受锁定钢板（LP）治疗的患者和101例接受锁定钢板联合骨移植（BG）治疗的患者。通过倾向得分匹配分析调整结果的潜在混杂因素。对于回顾性队列研究，每组62例患者接受影像学和临床结果评估并进行比较。
每组62例患者，平均年龄均为52岁，LP组平均随访时间为25个月，BG组为26个月。倾向得分匹配后，两组在人口统计学或手术特征方面无差异。在影像学结果方面，BG组颈干角（-5.1±4.9 vs. -3.1±5.3，p = 0.015）和肱骨头高度（-1.5±2.5 vs. -0.4±2.7，p = 0.002）的变化更明显。然而，在功能结果方面，两组在DASH评分、Constant-Murley评分或VAS评分方面无显著差异。此外，两组的并发症发生率无显著差异。
对于65岁以下的患者，在PHF锁定钢板固定后，同种异体骨移植仅在影像学上对稳定性有轻微改善，但不能改善肩部功能、缓解疼痛或减少并发症。我们得出结论，对于年轻的移位PHF患者，同种异体骨移植是不必要的。
