Willauschus Maximilian, Grimme Sebastian, Loose Kim, Rüther Johannes, Millrose Michael, Biber Roland, Gesslein Markus, Bail Hermann Josef
Department of Orthopedics and Traumatology, General Hospital Nuremberg, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Germany.
Department of Trauma Surgery and Sports Medicine, Garmisch-Partenkirchen Medical Centre, 82467 Garmisch-Partenkirchen, Germany.
J Pers Med. 2023 Aug 1;13(8):1224. doi: 10.3390/jpm13081224.
Proximal humeral fractures (PHFs) are common injuries that can lead to significant functional impairment. This retrospective cohort study aimed to evaluate the clinical outcomes and complications associated with the use of the Targon PH+ (Fa. Aesculap, Germany) intramedullary nail for the treatment of PHFs.
A subgroup consisting of 70 patients with a mean follow-up of 4.91 years out of 479 patients who underwent treatment with the Targon PH+ intramedullary nail for PHFs at a single center between 2014 and 2021 were included. Patient-reported outcome measures (PROMs) and health-related quality of life (HRQoL) were assessed using validated German versions of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, American Shoulder and Elbow Surgeons (ASES) score, Oxford Shoulder Score (OSS), and EuroQol 5-Dimension 5-Level (EQ-5D-5L). Radiographic assessment was performed using pre- and postoperative imaging.
Among the 70 patients of the subgroup who completed follow-up, 21.4% experienced complications, including major complications in 15.7% of cases, all of which were revised (revision rate of 15.7%). Anatomical reduction was achieved in 48,5% of cases. The mean DASH, ASES, and OSS scores were 25.4 ± 22.0, 76.2 ± 21.1, and 38.8 ± 10.3, respectively. Significant correlations were observed among the PROMs, indicating their convergent validity. Additionally, a significant correlation of all used PROMs and patient well-being (HRQoL) was observed. Severe complications and revisions were associated with significantly lower ASES scores (-11.1%, = 0.013). There was a tendency for PROM scores to slightly decline with increasing fracture complexity, although this trend did not reach statistical significance. Our findings indicate that patients over the age of 65 years tend to exhibit lower scores in PROMs and HRQoL measures.
The use of the Targon PH+ intramedullary nail for the treatment of PHFs resulted in satisfactory clinical outcomes and acceptable complication and revision rates. The PROMs and HRQoL measures indicated varying levels of disability and symptoms, with major complications, revision surgery, and age negatively impacting shoulder function after midterm follow-up.
肱骨近端骨折（PHFs）是常见损伤，可导致严重功能障碍。本回顾性队列研究旨在评估使用Targon PH+（德国蛇牌公司）髓内钉治疗PHFs的临床疗效及并发症。
纳入在2014年至2021年期间于单一中心接受Targon PH+髓内钉治疗PHFs的479例患者中的一个亚组，共70例，平均随访4.91年。使用经过验证的德语版上肢、肩部和手部功能障碍（DASH）问卷、美国肩肘外科医师（ASES）评分、牛津肩部评分（OSS）以及欧洲五维健康量表（EQ-5D-5L）对患者报告的结局指标（PROMs）和健康相关生活质量（HRQoL）进行评估。利用术前和术后影像学进行放射学评估。
在完成随访的该亚组70例患者中，21.4%发生并发症，其中15.7%为严重并发症，所有严重并发症均进行了翻修（翻修率为15.7%）。48.5%的病例实现了解剖复位。DASH、ASES和OSS的平均评分分别为25.4±22.0、76.2±21.1和38.8±10.3。在PROMs之间观察到显著相关性，表明它们具有收敛效度。此外，观察到所有使用的PROMs与患者幸福感（HRQoL）之间存在显著相关性。严重并发症和翻修与ASES评分显著降低相关（-11.1%，P = 0.013）。尽管这一趋势未达到统计学显著性，但随着骨折复杂性增加，PROM评分有轻微下降的趋势。我们的研究结果表明，65岁以上患者在PROMs和HRQoL测量中的得分往往较低。
使用Targon PH+髓内钉治疗PHFs取得了令人满意的临床疗效以及可接受的并发症和翻修率。PROMs和HRQoL测量显示了不同程度的残疾和症状，中期随访后，严重并发症、翻修手术和年龄对肩部功能产生负面影响。
