METHODS: In this 10-year retrospective study, we assessed 305 patients from a single center. All cases were treated with a PHILOS plate through a deltopectoral approach. The mean follow-up time was 467 days. The primary endpoint was HHN.
RESULTS: HHN was diagnosed in 12 patients (4%), 10 of which were diagnosed within the first year and one case 4 years after surgery. A positive correlation (p < 0.04) was found between HHN and fracture type (both in AO and Neer\'s classification), initial neck-shaft-angle (NSA) and metaphyseal head extension (MHE). Medial hinge displacement (MHD) occurred in all HHN cases. Achieving perfect reduction (< 2 mm dislocation) was relevant to avoiding HHN (p = 0.035). Although HHN developed in 32% of the high risk cases (four-part fractures with a short MHE), it was completely avoided (0%) when perfect reduction was achieved. Time until surgery after admission was neither a protective nor a risk factor for HHN.
CONCLUSIONS: We conclude that fracture complexity (four-part and C-fractures) as well as disruption of the medial hinge with a metaphyseal head extension smaller than 8 mm are relevant risk factors for humerus head necrosis. A combination of these criteria generated an high risk pattern with a 32% rate of HHN. Though often difficult to achieve, perfect reduction was a clear protective factor and reduced HHN to 0%. Perfect reduction may be key to inosculation and, therefore, salvage of the humerus head, especially in high risk cases. Surgery timing did not correlate with HHN.
METHODS: Level 3, retrospective cohort study.
方法:在这项为期10年的回顾性研究中,我们评估了来自一个中心的305例患者.所有病例均通过三角肌入路用PHILOS板治疗。平均随访时间为467天。主要终点为HHN。
结果:在12例患者(4%)中诊断为HHN,其中10例在手术后第一年内被诊断出,1例在手术后4年被诊断出。HHN与骨折类型(AO和Neer分类)呈正相关(p<0.04),初始颈轴角(NSA)和干骨干端头部延伸(MHE)。所有HHN病例均发生内侧铰链位移(MHD)。实现完美复位(<2mm位错)与避免HHN(p=0.035)相关。尽管在32%的高风险病例中出现了HHN(短MHE的四部分骨折),当达到完美还原时,它被完全避免(0%)。入院后直到手术的时间既不是HHN的保护因素,也不是HHN的危险因素。
结论:我们得出结论,骨折复杂性(四部分骨折和C型骨折)以及干phy端头部延伸小于8mm的内侧铰链破裂是肱骨头坏死的相关危险因素。这些标准的组合产生了高风险模式,HHN率为32%。虽然往往难以实现,完美还原是一个明显的保护因素,并将HHN降至0%。完美的减少可能是融合的关键,因此,肱骨头的打捞,特别是在高风险的情况下。手术时机与HHN无关。
方法:3级,回顾性队列研究。