Kimmeyer Michael, Liebherr Norbert, Schmalzl Jonas, Rentschler Verena, Gerhardt Christian, Lehmann Lars-Johannes
Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, Karlsruhe, D-76135, Germany.
Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
BMC Musculoskelet Disord. 2024 Dec 20;25(1):1053. doi: 10.1186/s12891-024-08156-9.
The aim of the study was to determine preoperative patient- and fracture-related risk factors for estimating the risk of fracture sequelae after surgically treated proximal humerus fractures (PHF) using locking plate osteosynthesis. The purpose was to develop a fracture sequelae risk score as an additional tool to facilitate the treatment strategy for PHF.
All patients with PHF who underwent surgery with locking plate osteosynthesis were included. Inclusion criteria were complete preoperative parameters including general patient-specific information, preoperative radiographs and computed tomography (CT) scans. The patients were divided into 2 groups according to the occurrence of fracture sequelae (Group I: no fracture sequelae, Group II: fracture sequelae). Following risk factors for fracture sequelae were defined: Vascular supply interruption risk [V], Individual (female gender) [I], Diabetes [D], ISAR (Identification of Seniors at risk) [I], ASA (American Society of Anesthesiologists) score [A], Body mass index [B], Osteopenia [O], Nicotine abuse [N], Elderly > 65 [E]. The VIDIA BONE score contains 9 items. For each parameter of the VIDIA BONE score, a value between 1 and 3 was assigned based on the odds ratio (OR).
This comparative case series study included 112 patients, with 82 (73.2%) in Group I and 30 (26.8%) in Group II. All defined preoperative risk factors were associated with an increased risk of fracture sequelae (FS), with odds ratios (OR) ranging from 1.3 to 3.9, although not all parameters reached statistical significance. The maximum score was 24 points, categorized as follows: scores of 1 to 8 indicating low risk, 9 to 16 indicating moderate risk, and 17 to 24 indicating high risk of fracture sequelae following PHF. Patients with a VIDIA BONE score of 1 to 8 points demonstrated favorable postoperative outcomes, with FS observed in only 6% of cases. In contrast, 84% of patients with a score of 17 to 24 developed a FS. Additionally, 90% of all patients who developed FS had a VIDIA BONE score more than 9 points.
The VIDIA BONE score appears to be a simple, reproducible, and valuable tool for supporting reliable treatment decisions. Locking plate osteosynthesis is an effective treatment option for patients with a low risk VIDIA BONE score. However, patients with a high risk VIDIA BONE score are more likely to experience FS and osteosynthesis failure.
III.
本研究旨在确定术前患者及骨折相关风险因素，以评估采用锁定钢板接骨术治疗的肱骨近端骨折（PHF）术后骨折后遗症的风险。目的是开发一种骨折后遗症风险评分，作为辅助PHF治疗策略的额外工具。
纳入所有接受锁定钢板接骨术的PHF患者。纳入标准包括完整的术前参数，包括患者的一般信息、术前X线片和计算机断层扫描（CT）。根据骨折后遗症的发生情况将患者分为两组（I组：无骨折后遗症，II组：有骨折后遗症）。定义了以下骨折后遗症的风险因素：血管供应中断风险[V]、个体因素（女性）[I]、糖尿病[D]、高危老年人识别（ISAR）[I]、美国麻醉医师协会（ASA）评分[A]、体重指数[B]、骨质减少[O]、尼古丁滥用[N]、年龄>65岁[E]。VIDIA BONE评分包含9项内容。对于VIDIA BONE评分的每个参数，根据优势比（OR）赋予1至3之间的值。
本比较病例系列研究纳入112例患者，I组8２例（７３.２％），II组30例（26.8％）。所有定义的术前风险因素均与骨折后遗症（FS）风险增加相关，优势比（OR）在1.3至3.9之间，尽管并非所有参数均达到统计学意义。最高评分为24分，分类如下：1至8分表示低风险，9至１6分表示中度风险，17至24分表示PHF后骨折后遗症高风险。VIDIA BONE评分为1至8分的患者术后结果良好，仅6％的病例出现FS。相比之下，评分为17至24分的患者中有84％出现FS。此外，所有发生FS的患者中有90％的VIDIA BONE评分超过9分。
VIDIA BONE评分似乎是一种简单、可重复且有价值的工具，有助于做出可靠的治疗决策。锁定钢板接骨术是VIDIA BONE评分低风险患者的有效治疗选择。然而，VIDIA BONE评分高风险的患者更有可能出现FS和接骨术失败。
III级。
