PDF(Pubmed)
Abstract：
BACKGROUND: Open reduction and internal fixation (ORIF) using locking plates is a widely adopted treatment for displaced proximal humerus fractures. Various augmentation techniques have been developed to enhance the stability of plate fixation. Among these, iliac bone autograft is notable for its advantages over allografts, such as ready availability and the elimination of costs and risks associated with disease transmission. Despite its potential benefits, data on the outcomes of iliac bone autograft augmentation (IBAA) are still limited. This study aims to present the mid- to long-term results of treating proximal humerus fractures with ORIF using locking plates and IBAA.
METHODS: The study included 15 patients treated with ORIF and IBAA. We classified fracture patterns using the Neer classification and estimated local bone density via the deltoid tuberosity index. We measured the neck shaft angle (NSA) and humeral head height (HHH) on both immediate postoperative and most recent X-ray images to assess the maintenance of reduction. Clinical outcomes were evaluated using the DASH (Disabilities of the Arm, Shoulder, and Hand) and Constant scores.
RESULTS: The average follow-up duration was 59.56 months, ranging from 24 to 93 months. A majority of fractures were classified as four-part (53%). The average immediate and late postoperative NSAs were 132.6±8.19 and 131.6±7.32 degrees, respectively. The average HHH on the immediate postoperative and latest follow-up images were 16.46±6.07 and 15.10±5.34, respectively. None of the patients exhibited any radiological signs of avascular necrosis or loss of reduction at the latest follow-up. The mean postoperative Constant and DASH scores at the latest follow-up were 79.6 and 11.5, respectively.
CONCLUSIONS: Our findings suggest that ORIF with IBAA is an effective method for managing three- or four-part proximal humerus fractures, yielding excellent outcomes.
METHODS: The study included 15 patients treated with ORIF and IBAA. We classified fracture patterns using the Neer classification and estimated local bone density via the deltoid tuberosity index. We measured the neck shaft angle (NSA) and humeral head height (HHH) on both immediate postoperative and most recent X-ray images to assess the maintenance of reduction. Clinical outcomes were evaluated using the DASH (Disabilities of the Arm, Shoulder, and Hand) and Constant scores.
RESULTS: The average follow-up duration was 59.56 months, ranging from 24 to 93 months. A majority of fractures were classified as four-part (53%). The average immediate and late postoperative NSAs were 132.6±8.19 and 131.6±7.32 degrees, respectively. The average HHH on the immediate postoperative and latest follow-up images were 16.46±6.07 and 15.10±5.34, respectively. None of the patients exhibited any radiological signs of avascular necrosis or loss of reduction at the latest follow-up. The mean postoperative Constant and DASH scores at the latest follow-up were 79.6 and 11.5, respectively.
CONCLUSIONS: Our findings suggest that ORIF with IBAA is an effective method for managing three- or four-part proximal humerus fractures, yielding excellent outcomes.
摘要：
背景：使用锁定钢板的切开复位内固定（ORIF）是一种广泛采用的治疗移位的肱骨近端骨折的方法。已经开发了各种增强技术来增强板固定的稳定性。其中,自体髂骨移植以其优于同种异体移植的优势而著称，例如随时可用，消除与疾病传播相关的成本和风险。尽管有潜在的好处,关于自体骨移植(IBAA)结果的数据仍然有限.本研究旨在介绍使用锁定钢板和IBAA用ORIF治疗肱骨近端骨折的中长期结果。
方法：本研究包括15例接受ORIF和IBAA治疗的患者。我们使用Neer分类法对骨折类型进行了分类，并通过三角肌结节指数估计了局部骨密度。我们在术后即刻和最近的X射线图像上测量了颈轴角（NSA）和肱骨头高度（HHH），以评估复位的维持情况。使用DASH（手臂残疾，肩膀,和手）和恒定分数。
结果：平均随访时间为59.56个月，从24到93个月不等。大多数骨折分为四部分（53％）。术后即刻和晚期平均NSA分别为132.6±8.19和131.6±7.32度,分别。术后即刻和最新随访图像的平均HHH分别为16.46±6.07和15.10±5.34。在最近的随访中，没有患者表现出任何缺血性坏死或减少的放射学征象。最近一次随访的平均术后Constant和DASH评分分别为79.6和11.5。
结论：我们的研究结果表明，ORIF联合IBAA是治疗肱骨近端三部分或四部分骨折的有效方法，产生优异的结果。
方法：本研究包括15例接受ORIF和IBAA治疗的患者。我们使用Neer分类法对骨折类型进行了分类，并通过三角肌结节指数估计了局部骨密度。我们在术后即刻和最近的X射线图像上测量了颈轴角（NSA）和肱骨头高度（HHH），以评估复位的维持情况。使用DASH（手臂残疾，肩膀,和手）和恒定分数。
结果：平均随访时间为59.56个月，从24到93个月不等。大多数骨折分为四部分（53％）。术后即刻和晚期平均NSA分别为132.6±8.19和131.6±7.32度,分别。术后即刻和最新随访图像的平均HHH分别为16.46±6.07和15.10±5.34。在最近的随访中，没有患者表现出任何缺血性坏死或减少的放射学征象。最近一次随访的平均术后Constant和DASH评分分别为79.6和11.5。
结论：我们的研究结果表明，ORIF联合IBAA是治疗肱骨近端三部分或四部分骨折的有效方法，产生优异的结果。
