Rusimov Lyubomir, Baltov Asen, Enchev Dian, Gueorguiev Boyko, Prodanova Krasimira, Hadzhinikolova Mariya, Rusimov Vladimir, Rashkov Mihail
Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov", Sofia, Bulgaria.
AO Research Institute Davos, Davos, Switzerland.
Shoulder Elbow. 2025 Apr;17(2):189-199. doi: 10.1177/17585732241246718. Epub 2024 Apr 16.
This retrospective clinical study aims to compare the functional and radiological outcomes after open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with both locking plate and intramedullary graft.
Forty-seven patients with proximal humerus fractures were treated with either open reduction and internal fixation (25 cases) or minimally invasive plate osteosynthesis (22 cases) and evaluated retrospectively with a minimum follow-up of 12 months. Thirty-one fresh-frozen fibulae and 16 lyophilized tibia allografts were used for augmentation. Change of both neck-shaft angle and humeral head height were evaluated radiologically. Functional outcomes were assessed using Disabilities of the Arm, Shoulder and Hand Score (DASH), Absolute Constant-Murley Score (CS), Relative Constant-Murley Score (CS), and Individual Relative Constant-Murley Score (CS).
Follow-up period and age for open reduction and internal fixation/minimally invasive plate osteosynthesis were 27.4 ± 16.2/29.6 ± 17.6 months and 60.5 ± 13.7/66.3 ± 11.7 years. CS, CS, and CS were 57.3 ± 21.2/52.4 ± 18.9, 73 ± 24.1/73.9 ± 23.4, and 69.6 ± 24.8/64 ± 25.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, ≥ 0.409. DASH was 14.8 ± 12.5/18.7 ± 14.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, = 0.324. Decrease of neck-shaft angle and humeral head height was 7.8 ± 9.4/8.2 ± 15.6° and 0.6 ± 5.5/1.4 ± 2.6 mm for open reduction and internal fixation/minimally invasive plate osteosynthesis, ≥ 0.380. Surgical time was 165.8 ± 77.6/84.7 ± 38.1 min for open reduction and internal fixation/minimally invasive plate osteosynthesis, < 0.001.
Locked plating with intramedullary graft augmentation of unstable proximal humerus fractures demonstrates similar functional and radiological outcomes when comparing open reduction and internal fixation with minimally invasive plate osteosynthesis. However, minimally invasive plate osteosynthesis is related to significantly shorter surgical time versus open reduction and internal fixation.
本回顾性临床研究旨在比较采用锁定钢板和髓内植骨治疗不稳定型肱骨近端骨折时，切开复位内固定与微创钢板接骨术的功能和影像学结果。
47例肱骨近端骨折患者接受了切开复位内固定（25例）或微创钢板接骨术（22例）治疗，并进行回顾性评估，最短随访时间为12个月。使用31根新鲜冷冻腓骨和16根冻干胫骨异体骨进行增强。通过影像学评估颈干角和肱骨头高度的变化。使用手臂、肩部和手部功能障碍评分（DASH）、绝对Constant-Murley评分（CS）、相对Constant-Murley评分（CS）和个体相对Constant-Murley评分（CS）评估功能结果。
切开复位内固定/微创钢板接骨术的随访时间和年龄分别为27.4±16.2/29.6±17.6个月和60.5±13.7/66.3±11.7岁。切开复位内固定/微创钢板接骨术的CS、CS和CS分别为57.3±21.2/52.4±18.9、73±24.1/73.9±23.4和69.6±24.8/64±25.5，P≥0.409。切开复位内固定/微创钢板接骨术的DASH为14.8±12.5/18.7±14.5，P=0.324。切开复位内固定/微创钢板接骨术的颈干角和肱骨头高度降低分别为7.8±9.4/8.2±15.6°和0.6±5.5/1.4±2.6mm，P≥0.380。切开复位内固定/微创钢板接骨术的手术时间分别为165.8±77.6/84.7±38.1分钟，P<0.001。
在比较切开复位内固定与微创钢板接骨术时，采用髓内植骨增强的锁定钢板治疗不稳定型肱骨近端骨折显示出相似的功能和影像学结果。然而，与切开复位内固定相比，微创钢板接骨术的手术时间明显更短。
