Etemad-Rezaie Ali, Dienes Serena, Gohal Chetan, Politis-Barber Valerie, Searle Stephanie, Nam Diane, Sheth Ujash
Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
J Orthop. 2024 Jul 26;59:97-105. doi: 10.1016/j.jor.2024.07.017. eCollection 2025 Jan.
To systematically identify and evaluate different bone graft augmentation techniques in the operative treatment of complex proximal humerus fractures.
Four databases were searched from 1970 to February 2023 for Level I to IV English studies that investigated outcomes of different bone augments in the primary surgical fixation of proximal humerus fractures. The JBI critical appraisal checklist, methodological index for non-randomized studies and cochrane risk of bias tool were used to assess study quality. Descriptive statistics including weighted means are presented where applicable.
Thirty-three articles including 964 patients met the inclusion. Seven bone augments were identified, including fibular strut allograft (693 patients across 21 studies), femoral head allograft (84 patients across 4 studies), iliac crest allograft (54 patients across 3 studies), iliac crest autograft (94 patients across 5 studies), humeral endosteal allograft (6 patients in 1 single study), unspecified cancellous allograft (28 patients in 1 single study) and distal clavicle autograft (3 patients in 1 single study). Mean patient age was 67.1 years, with female patients comprising 65.2 %. Fracture union rates were similar between groups, with an average of 99.6 %. The average Constant Murley Score (CMS) was not reported in the humeral endosteal allograft or the distal clavicle autograft group but was 81.8 (fibular strut allograft), 79.1 (femoral head allograft), 76.8 (iliac crest allograft), 77.7 (iliac crest autograft), and 81.5 (unspecified cancellous allograft) in the remaining groups. Revision surgery was required in 16.7 % of patients receiving humeral endosteal allograft, 7 % of patients with femoral head allograft, 2 % of iliac crest autografts and 1.9 % in the fibular allograft group. Reported complications included avascular necrosis, hardware complications and loss of reduction.
Bone graft augmentation is an effective adjunct to open reduction internal fixation of complex proximal humerus fractures. Fibular strut allograft is the most common bone graft augment used. Majority of patients treated with bone graft augmentation achieved bony union (83%-100 %) and average CMS scores at final follow-up were similar between graft types (76-82). However, no conclusive data suggests superiority of one bone graft type over another. Future studies should aim to compare the outcomes amongst graft types.
系统识别和评估复杂肱骨近端骨折手术治疗中不同的骨移植增强技术。
检索了四个数据库，时间跨度从1970年至2023年2月，查找关于I至IV级英文研究，这些研究调查了不同骨增强材料在肱骨近端骨折一期手术固定中的效果。使用JBI批判性评价清单、非随机研究方法学指标和Cochrane偏倚风险工具来评估研究质量。在适用的情况下呈现包括加权均值在内的描述性统计数据。
33篇文章共964例患者符合纳入标准。识别出七种骨增强材料，包括腓骨支撑异体骨（21项研究中的693例患者）、股骨头异体骨（4项研究中的84例患者）、髂嵴异体骨（3项研究中的54例患者）、髂嵴自体骨（5项研究中的94例患者）、肱骨骨内膜异体骨（1项单一研究中的6例患者）、未指明的松质骨异体骨（1项单一研究中的28例患者）和锁骨远端自体骨（1项单一研究中的3例患者）。患者平均年龄为67.1岁，女性患者占65.2%。各组骨折愈合率相似，平均为99.6%。肱骨骨内膜异体骨组或锁骨远端自体骨组未报告平均Constant Murley评分（CMS），但其余组的评分为：腓骨支撑异体骨组81.8分、股骨头异体骨组79.1分、髂嵴异体骨组76.8分、髂嵴自体骨组77.7分、未指明的松质骨异体骨组81.5分。接受肱骨骨内膜异体骨移植的患者中有16.7%需要翻修手术，股骨头异体骨移植患者中有7%、髂嵴自体骨移植患者中有2%、腓骨异体骨移植组中有1.9%需要翻修手术。报告的并发症包括缺血性坏死、内固定并发症和复位丢失。
骨移植增强是复杂肱骨近端骨折切开复位内固定的有效辅助手段。腓骨支撑异体骨是最常用的骨移植增强材料。大多数接受骨移植增强治疗的患者实现了骨愈合（83%-100%），不同移植类型在最终随访时的平均CMS评分相似（76-82分）。然而，没有确凿数据表明一种骨移植类型优于另一种。未来的研究应旨在比较不同移植类型的效果。
