Abstract：
BACKGROUND: The risk of avascular necrosis, nonunion, or malunion is high in osteoporosis-related 4-part fractures. We evaluated the results of patients who underwent plate osteosynthesis with a vascularized pectoralis major graft compared with tricortical iliac grafting to treat 4-part proximal humerus fractures.
METHODS: Thirty-four patients aged 50-75 years with Neer 4-part proximal humerus fractures were studied. Group A (n = 17) underwent osteotomy of a 2.5 ± 1 cm pectoralis major pedicle bone graft and plate application, whereas group B (n = 17) underwent plate osteosynthesis using iliac autogenous grafts. Final follow-up assessments included evaluation using Constant and American Shoulder and Elbow Surgeons scoring systems, humeral neck-shaft angle (HNSA), humeral head height, and humeral head avascular necrosis.
RESULTS: Reduction loss was observed in 3 patients (17.6%) in group A, whereas it was observed in 10 patients (58.8%) in group B (P = .013). Humeral head avascular necrosis was found in 1 patient (5.8%) in group A, whereas it was found in 5 patients (29.4%) in the other group (P = .071). The HNSA was normal in 12 (70.5%) of group A patients, whereas it was normal in 6 (35.2%) of group B patients. The HNSA was weak or bad (<1200) in 29.4% of group A patients, whereas this rate was 64.7% in group B patients. Humeral head height was 2.64 ± 1.45 mm in group A and 3.66 ± 1.65 mm in group B. There were no statistically significant differences between the 2 groups in terms of Constant and American Shoulder and Elbow Surgeons scoring systems.
CONCLUSIONS: Pectoralis major bone pedicle graft in Neer 4-part proximal humerus fractures reduces the risk of avascular necrosis and nonunion rates. Our technique yielded excellent clinical and radiological results. We achieved recovery without creating additional donor site morbidity.
METHODS: Thirty-four patients aged 50-75 years with Neer 4-part proximal humerus fractures were studied. Group A (n = 17) underwent osteotomy of a 2.5 ± 1 cm pectoralis major pedicle bone graft and plate application, whereas group B (n = 17) underwent plate osteosynthesis using iliac autogenous grafts. Final follow-up assessments included evaluation using Constant and American Shoulder and Elbow Surgeons scoring systems, humeral neck-shaft angle (HNSA), humeral head height, and humeral head avascular necrosis.
RESULTS: Reduction loss was observed in 3 patients (17.6%) in group A, whereas it was observed in 10 patients (58.8%) in group B (P = .013). Humeral head avascular necrosis was found in 1 patient (5.8%) in group A, whereas it was found in 5 patients (29.4%) in the other group (P = .071). The HNSA was normal in 12 (70.5%) of group A patients, whereas it was normal in 6 (35.2%) of group B patients. The HNSA was weak or bad (<1200) in 29.4% of group A patients, whereas this rate was 64.7% in group B patients. Humeral head height was 2.64 ± 1.45 mm in group A and 3.66 ± 1.65 mm in group B. There were no statistically significant differences between the 2 groups in terms of Constant and American Shoulder and Elbow Surgeons scoring systems.
CONCLUSIONS: Pectoralis major bone pedicle graft in Neer 4-part proximal humerus fractures reduces the risk of avascular necrosis and nonunion rates. Our technique yielded excellent clinical and radiological results. We achieved recovery without creating additional donor site morbidity.
摘要：
背景：缺血性坏死的风险，骨不连,或不愈合在骨质疏松症相关的四部分骨折中很高。我们试图评估接受血管化胸大肌钢板内固定术的患者的结果，与三皮质髂骨移植治疗4部分肱骨近端骨折相比。
方法：研究了34例年龄在50-75岁之间的Neer4段肱骨近端骨折患者。A组(n=17)行2.5cm±1cm胸大肌椎弓根植骨截骨并应用钢板,而B组（n=17）使用自体骨移植物进行钢板接骨术。最终的随访评估包括使用恒定和美国肩肘外科医生评分系统进行评估，肱骨颈-轴角(HNSA),肱骨头高度（肱骨头高度）和肱骨头缺血性坏死。
结果：尽管在A组患者中有3例患者（17.6％）观察到减少损失，B组中有10例患者（58.8％）观察到减少损失，p=0.013。A组肱骨头缺血性坏死1例(5.8%),而另一组为5（29.4%）（p=0.071）。A组12例(70.5%)患者HNSA正常,而B组6例(35.2%)患者正常。29.4%的A组患者HNSA弱或差（<1200），而B组患者的这一比率为64.7%。A组HHH为2.64±1.45mm,B组HHH为3.66±1.65mm,两组在常数和美国肩肘外科医生评分系统方面无统计学差异。
结论：在Neer4部分肱骨近端骨折中，胸大肌骨移植可降低缺血性坏死和骨不愈合的风险。我们的技术产生了出色的临床和放射学结果。我们在没有造成额外供体部位发病率的情况下实现了康复。
方法：研究了34例年龄在50-75岁之间的Neer4段肱骨近端骨折患者。A组(n=17)行2.5cm±1cm胸大肌椎弓根植骨截骨并应用钢板,而B组（n=17）使用自体骨移植物进行钢板接骨术。最终的随访评估包括使用恒定和美国肩肘外科医生评分系统进行评估，肱骨颈-轴角(HNSA),肱骨头高度（肱骨头高度）和肱骨头缺血性坏死。
结果：尽管在A组患者中有3例患者（17.6％）观察到减少损失，B组中有10例患者（58.8％）观察到减少损失，p=0.013。A组肱骨头缺血性坏死1例(5.8%),而另一组为5（29.4%）（p=0.071）。A组12例(70.5%)患者HNSA正常,而B组6例(35.2%)患者正常。29.4%的A组患者HNSA弱或差（<1200），而B组患者的这一比率为64.7%。A组HHH为2.64±1.45mm,B组HHH为3.66±1.65mm,两组在常数和美国肩肘外科医生评分系统方面无统计学差异。
结论：在Neer4部分肱骨近端骨折中，胸大肌骨移植可降低缺血性坏死和骨不愈合的风险。我们的技术产生了出色的临床和放射学结果。我们在没有造成额外供体部位发病率的情况下实现了康复。
