■治疗复杂的三部分和四部分肱骨近端骨折,尤其是老年人,仍然有争议,锁定钢板内固定和肩关节成形术是主要选择。尽管肱骨近端锁定钢板比肩关节置换更常用,他们的并发症发生率很高。骨密度低等因素,高龄,多处碎片骨折,和内侧皮质支持丢失对治疗结果产生负面影响。这项研究评估了使用锁定钢板治疗50岁及以上患者骨折的功能和影像学结果。以及影响胡志明市医院创伤和骨科预后和并发症发生率的因素。
■对58名50岁及以上的患者(15名男性,43名女性),三部分和四部分肱骨近端骨折。这些患者于2020年4月至2022年4月在胡志明市创伤和骨科医院(HTO)接受了切开复位和锁定加压钢板(LCP)肱骨周围近端钢板内固定。术后最短随访时间为12个月。
■患者的平均年龄为62.78±7.73岁,平均随访26.24±5.93个月。其中,41例有三部分骨折(70.68%),17例有四部分骨折(29.32%)。在最后一次随访(≥12个月),Constant-Murley平均得分为70.81±9.15,QDASH平均得分为8.33±2.77。并发症6例(10.34%)。复杂骨折,如位移大于2mm的四部分骨折,Constant-Murley得分较低,QDASH得分较高(p<0.05)。年龄,性别,通过三角肌结节指数(DTI),骨移植,肩袖缝合显示出类似的趋势,但差异无统计学意义。
■切开复位内固定(ORIF)为三部分和四部分肱骨近端骨折提供了良好的骨愈合和功能结局。年龄等因素,性别,骨密度,骨移植,肩袖缝合对结局无显著影响.因此,在这些病例中,使用锁定钢板的ORIF不应该是骨质疏松的禁忌症.复杂骨折,然而,通常导致较差的预后和较高的术后并发症发生率.
UNASSIGNED: Treating complex three- and four-part proximal humerus fractures, especially in the elderly, remains contentious, with internal fixation using locking plates and shoulder arthroplasty being primary options. Although proximal humerus locking plates are more commonly used than shoulder replacements, they have a high complication rate. Factors like low bone density, advanced age, multiple fragment fractures, and medial cortical support loss negatively impact treatment outcomes. This study evaluates the functional and radiographic outcomes of using locking plates for treating these fractures in patients aged 50 and older, and the factors influencing outcomes and complication rates at the Ho Chi Minh City Hospital for Trauma and Orthopedics.
UNASSIGNED: A descriptive case series study was conducted on 58 patients aged 50 and older (15 males, 43 females) with three- and four-part proximal humerus fractures. These patients underwent open reduction and internal fixation with Locking - compression plate (LCP) periarticular proximal humerus plates at the Ho Chi Minh City Hospital for Traumatology and Orthopedics (HTO) from April 2020 to April 2022. The minimum postoperative follow-up period was 12 months.
UNASSIGNED: The average age of the patients was 62.78 ± 7.73 years, with a mean follow-up of 26.24 ± 5.93 months. Among them, 41 had three-part fractures (70.68 %) and 17 had four-part fractures (29.32 %). At the final follow-up (≥12 months), the mean Constant-Murley score was 70.81 ± 9.15, and the mean QDASH score was 8.33 ± 2.77. Complications occurred in 6 cases (10.34 %). Complex fractures, such as four-part fractures with displacement greater than 2 mm, had lower Constant-Murley scores and higher QDASH scores (p < 0.05). Age, gender, bone density by deltoid tuberosity index (DTI), bone grafting, and rotator cuff sutures showed similar trends, but the differences were not statistically significant.
UNASSIGNED: Open reduction and internal fixation (ORIF) provides good bone healing and functional outcomes for three- and four-part proximal humerus fractures. Factors such as age, gender, bone density, bone grafting, and rotator cuff sutures do not significantly affect outcomes. Therefore, osteoporosis should not be a contraindication for ORIF with locking plates in these cases. Complex fractures, however, often lead to poorer outcomes and higher complication rates post-surgery.