Wang Zongpu, Wang Tienan, Qin Song, Wang Jianchuan
Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
School of Mechanical Engineering, Dalian Jiaotong University, Dalian, China.
Front Surg. 2025 Jan 15;11:1472054. doi: 10.3389/fsurg.2024.1472054. eCollection 2024.
To compare the efficacy of three treatment methods for older adult patients with osteoporotic proximal humerus fractures: proximal humerus locking plate (PHILOS) combined with calcium sulfate injection, PHILOS plate alone, and artificial hemi-shoulder joint replacement.
The clinical data of 48 older adult patients with osteoporotic proximal humerus fractures admitted to the Shoulder and Elbow Surgery Department of Zhongshan Hospital Affiliated with Dalian University from February 2018-August 2021 were retrospectively analyzed. The patients comprised 18 males and 30 females, with a mean age of (68.6 ± 5.8) years. The 48 patients were divided into three groups based on their treatment methods: Group A: 16 patients treated with PHILOS plate combined with calcium sulfate injection. Group B: 16 patients treated with the PHILOS plate alone. Group C: 16 patients treated with artificial hemi-shoulder joint replacement. Key parameters such as operation time, blood loss, incision length, operation cost, and shoulder joint motion at the final follow-up were recorded and compared. Shoulder joint function was evaluated using the American Shoulder and Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS) for pain, University of California Shoulder Joint Score (UCLA), and Brief Shoulder Function Test (SST).
There were no statistically significant differences in the preoperative general data between the three groups ( > 0.05), indicating comparability. There was no significant difference in operation time, blood loss, and incision length among Groups A, B, and C ( > 0.05). However, Group C had significantly higher operation costs compared to the other two groups ( < 0.05). At the final follow-up, there were no significant differences in shoulder flexion and rotation among the three groups ( > 0.05). However, a statistically significant difference in abduction was observed between Group A and Group C ( < 0.05). No significant differences were found in ASES, VAS, UCLA, and SST scores among the three groups at the last follow-up ( > 0.05).Complications occurred in 1 patient (Group A), 3 patients (Group B), and 4 patients (Group C), showing a statistically significant difference among the groups ( < 0.05).
All three surgical methods are effective in treating older adult osteoporotic proximal humerus fractures, as they significantly alleviate pain and restore joint function. However, the use of a PHILOS plate combined with calcium sulfate injection (Group A) is particularly effective, demonstrating reliable clinical efficacy with fewer complications.
比较三种治疗方法对老年骨质疏松性肱骨近端骨折患者的疗效：肱骨近端锁定钢板（PHILOS）联合硫酸钙注射、单纯PHILOS钢板以及人工半肩关节置换。
回顾性分析2018年2月至2021年8月大连大学附属中山医院肩肘外科收治的48例老年骨质疏松性肱骨近端骨折患者的临床资料。患者包括18例男性和30例女性，平均年龄为（68.6±5.8）岁。48例患者根据治疗方法分为三组：A组：16例采用PHILOS钢板联合硫酸钙注射治疗。B组：16例采用单纯PHILOS钢板治疗。C组：16例采用人工半肩关节置换治疗。记录并比较手术时间、出血量、切口长度、手术费用以及末次随访时肩关节活动度等关键参数。采用美国肩肘外科医师（ASES）评分、视觉模拟疼痛评分（VAS）、加州大学肩关节评分（UCLA）以及简易肩关节功能测试（SST）评估肩关节功能。
三组术前一般资料比较，差异无统计学意义（>0.05），具有可比性。A、B、C三组手术时间、出血量及切口长度比较，差异无统计学意义（>0.05）。然而，C组手术费用显著高于其他两组（<0.05）。末次随访时，三组肩关节前屈和旋转活动度比较，差异无统计学意义（>0.05）。但A组与C组外展活动度比较，差异有统计学意义（<0.05）。末次随访时，三组ASES、VAS、UCLA及SST评分比较，差异无统计学意义（>0.05）。A组1例、B组3例、C组4例出现并发症，组间比较差异有统计学意义（<0.05）。
三种手术方法均能有效治疗老年骨质疏松性肱骨近端骨折，可显著缓解疼痛并恢复关节功能。然而，采用PHILOS钢板联合硫酸钙注射（A组）尤其有效，临床疗效可靠，并发症较少。
