PDF(Pubmed)
Abstract：
UNASSIGNED: About 20% of proximal humerus fractures (PHFs) are unstable and/or markedly displaced and therefore require surgery. Locking plate fixation after anatomical reduction has become the current treatment of choice for these fractures in the active population. However, studies have shown complication rates up to 36%, such as loss of reduction and avascular necrosis. To date, data from literature are inconclusive on outcomes following the use of an intramedullary fibula allograft in PHFs, possibly due to the case mix. It is hypothesized that the use of a fibula allograft is beneficial to prevent secondary displacement of the fracture in cases where the medial hinge is markedly displaced and unstable, resulting in better clinical and patient reported outcomes.
UNASSIGNED: In this multicenter matched cohort study, patients with an unstable, displaced PHF, including anatomic neck fractures and significantly displaced surgical neck fractures, were included. Patients that were treated with a locking plate augmented with a fibula allograft were matched to patients who had undergone locking plate reconstruction without the allograft. The matches were made based on fracture characteristics, age, and performance status. Functional outcomes, Patient Reported Outcome Measures, complications, and radiographic results were compared.
UNASSIGNED: Twelve patients with fibula allograft augmented osteosyntheses were included and matched to 12 control patients. The mean age was 58 years in the fibula allograft group compared to 62 years in the control group. Minimum follow-up was 12 months. Disability of the Arm Shoulder and Hand score, Constant Shoulder score, abduction, and external rotation were significantly better in the fibula allograft group (17.4 ± 8.6 vs. 26.1 ± 19.2, P = .048; 16.5 ± 11.5 vs. 19.8 ± 16.5 P = .040; mean 127° ± 38° vs. mean 92° ± 49° P = -.045; 50° ± 21° vs. mean 26° ± 23°, P = .004). There was no statistically significant difference in the Oxford Shoulder score between groups (P = .105). The Visual Analog Scale was not significantly different between groups (3.1 ± 1.8 vs. 1.6 ± 1.9, P = .439). Radiographic union was reached in 11 patients of the fibula allograft group compared to 8 in the control group (P = .317). The complication rate was twice as high in the control group (3 vs. 7).
UNASSIGNED: Additional support of the medial hinge in unstable PHFs with a locking plate in combination with a fibula allograft appears to create a more stable construct without compromising the viability of the articular surface of the head. The use of a fibula allograft in selected complex cases could therefore result in better clinical outcomes with lower complication rates.
UNASSIGNED: In this multicenter matched cohort study, patients with an unstable, displaced PHF, including anatomic neck fractures and significantly displaced surgical neck fractures, were included. Patients that were treated with a locking plate augmented with a fibula allograft were matched to patients who had undergone locking plate reconstruction without the allograft. The matches were made based on fracture characteristics, age, and performance status. Functional outcomes, Patient Reported Outcome Measures, complications, and radiographic results were compared.
UNASSIGNED: Twelve patients with fibula allograft augmented osteosyntheses were included and matched to 12 control patients. The mean age was 58 years in the fibula allograft group compared to 62 years in the control group. Minimum follow-up was 12 months. Disability of the Arm Shoulder and Hand score, Constant Shoulder score, abduction, and external rotation were significantly better in the fibula allograft group (17.4 ± 8.6 vs. 26.1 ± 19.2, P = .048; 16.5 ± 11.5 vs. 19.8 ± 16.5 P = .040; mean 127° ± 38° vs. mean 92° ± 49° P = -.045; 50° ± 21° vs. mean 26° ± 23°, P = .004). There was no statistically significant difference in the Oxford Shoulder score between groups (P = .105). The Visual Analog Scale was not significantly different between groups (3.1 ± 1.8 vs. 1.6 ± 1.9, P = .439). Radiographic union was reached in 11 patients of the fibula allograft group compared to 8 in the control group (P = .317). The complication rate was twice as high in the control group (3 vs. 7).
UNASSIGNED: Additional support of the medial hinge in unstable PHFs with a locking plate in combination with a fibula allograft appears to create a more stable construct without compromising the viability of the articular surface of the head. The use of a fibula allograft in selected complex cases could therefore result in better clinical outcomes with lower complication rates.
摘要：
■大约20％的肱骨近端骨折（PHFs）不稳定和/或明显移位，因此需要手术。解剖复位后的锁定钢板固定已成为活跃人群中这些骨折的当前选择。然而,研究显示并发症发生率高达36%,如减少和血管坏死的损失。迄今为止,来自文献的数据对PHF中使用髓内腓骨同种异体移植物后的结果尚无定论，可能是由于案件的混合。假设在内侧铰链明显移位且不稳定的情况下，使用同种异体腓骨移植物有利于防止骨折的二次移位。导致更好的临床和患者报告的结果。
■在这项多中心配对队列研究中，不稳定的患者，位移PHF,包括解剖颈部骨折和明显移位的外科颈部骨折，包括在内。接受同种异体腓骨移植增强锁定板治疗的患者与没有同种异体移植的锁定板重建患者相匹配。比赛是根据骨折特征进行的，年龄,和性能状态。功能成果，患者报告的结果指标，并发症,和射线照相结果进行了比较。
■包括12例同种异体腓骨移植增强的骨合成患者，并与12例对照患者相匹配。同种异体腓骨移植组的平均年龄为58岁，而对照组为62岁。最短随访时间为12个月。臂肩和手的残疾评分，恒定肩关节评分,绑架,同种异体腓骨移植组和外旋转明显更好（17.4±8.6vs.26.1±19.2，P=.048；16.5±11.5vs.19.8±16.5P=.040；平均127°±38°vs.平均92°±49°P=-.045;50°±21°vs.平均26°±23°，P=.004）。两组之间的牛津肩评分无统计学差异（P=.105）。视觉模拟量表在组间没有显着差异（3.1±1.8vs.1.6±1.9，P=.439）。腓骨同种异体移植组的11例患者达到了影像学愈合，而对照组为8例（P=.317）。并发症发生率是对照组的两倍(3vs.7).
■在不稳定的PHF中，内侧铰链的额外支撑与同种异体腓骨移植相结合，似乎可以产生更稳定的结构，而不会损害头部关节表面的生存能力。因此，在选定的复杂病例中使用同种异体腓骨移植物可以获得更好的临床结果，并发症发生率较低。
■在这项多中心配对队列研究中，不稳定的患者，位移PHF,包括解剖颈部骨折和明显移位的外科颈部骨折，包括在内。接受同种异体腓骨移植增强锁定板治疗的患者与没有同种异体移植的锁定板重建患者相匹配。比赛是根据骨折特征进行的，年龄,和性能状态。功能成果，患者报告的结果指标，并发症,和射线照相结果进行了比较。
■包括12例同种异体腓骨移植增强的骨合成患者，并与12例对照患者相匹配。同种异体腓骨移植组的平均年龄为58岁，而对照组为62岁。最短随访时间为12个月。臂肩和手的残疾评分，恒定肩关节评分,绑架,同种异体腓骨移植组和外旋转明显更好（17.4±8.6vs.26.1±19.2，P=.048；16.5±11.5vs.19.8±16.5P=.040；平均127°±38°vs.平均92°±49°P=-.045;50°±21°vs.平均26°±23°，P=.004）。两组之间的牛津肩评分无统计学差异（P=.105）。视觉模拟量表在组间没有显着差异（3.1±1.8vs.1.6±1.9，P=.439）。腓骨同种异体移植组的11例患者达到了影像学愈合，而对照组为8例（P=.317）。并发症发生率是对照组的两倍(3vs.7).
■在不稳定的PHF中，内侧铰链的额外支撑与同种异体腓骨移植相结合，似乎可以产生更稳定的结构，而不会损害头部关节表面的生存能力。因此，在选定的复杂病例中使用同种异体腓骨移植物可以获得更好的临床结果，并发症发生率较低。
