Hoellen I P, Bauer G, Holbein O
Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinik Ulm.
Zentralbl Chir. 1997;122(11):994-1001.
In a prospective randomised study, comprising 30 aged patients with fractures of the proximal humerus (4-fragment fractures according to Neer) minimal osteosynthesis was compared to primary endoprosthetic replacement. The Constant score was used for evaluation during follow-up. After one year the results were similar in both groups. There were two complications necessitating revision surgery among the patients with minimal osteosynthesis and in four cases the implants had to be removed. In the group with primary endoprosthetic repair neither complications nor revision surgery occurred. Primary endoprosthetic replacement for the treatment of proximal humeral fractures appears as a therapeutic option with a low complication rate and a satisfying functional outcome. In older patients we need a safe mode of therapy permitting early mobilization and quick discharge from the hospital back to the patient's home. Endoprosthetic replacement fulfils these demands since it resembles a "one time surgery" without the risk of revision surgery for implant loosening, pseudarthrosis or ischemic necrosis of the humeral head.
在一项前瞻性随机研究中，纳入了30例老年肱骨近端骨折患者（根据Neer分类为四部分骨折），将微创接骨术与一期人工关节置换术进行比较。随访期间采用Constant评分进行评估。一年后，两组结果相似。微创接骨术组有2例并发症需要翻修手术，4例需要取出植入物。一期人工关节置换组未发生并发症和翻修手术。一期人工关节置换治疗肱骨近端骨折似乎是一种并发症发生率低且功能结果令人满意的治疗选择。对于老年患者，我们需要一种安全的治疗方式，允许早期活动并能快速出院回家。人工关节置换术满足了这些需求，因为它类似于“一次性手术”，不存在因植入物松动、假关节或肱骨头缺血坏死而进行翻修手术的风险。
