背景:肱骨近端cal是肱骨内侧柱支撑的基本结构。这项研究旨在评估不稳定肱骨近端骨折(PHFs)伴内侧call骨粉碎的骨合成结果。使用PHILOS锁定钢板和内侧支撑螺钉(MSS)进行治疗。
方法:2010年1月至2018年12月,我们回顾性分析了121例PHFs合并内侧柱断裂的骨连接术的结果。对于内侧支撑,在肱骨头下象限的软骨下骨5mm内插入至少一个斜螺钉。所有患者分为两组:单MSS组26例,和多MSS组中的95。至少一年后的随访包括临床和影像学结果评估,并相应地测量Constant-Murley分数,加州大学,洛杉矶(UCLA)肩秤,疼痛视觉模拟评分(VAS),主要并发症,颈轴角度(NSA),肱骨头高度(HHH),以及骨骼结合的最终时间。通过多变量逻辑回归分析评估主要并发症的危险因素。
结果:该队列的平均年龄为64.4±15.4岁,平均随访时间为19.5±7.6个月。在最后的后续行动中,在单个MSS和多个MSS组之间,Constant-Murley评分无显着差异(p=0.367),加州大学洛杉矶分校得分(p=0.558),VAS(p=0.571),骨愈合时间(p=0.621),NSA损失(p=0.424),观察到HHH损失(p=0.364)。基于MSS数目的并发症发生率(p=0.446)无显著差异。手术后(NSA<125°)的初始复位不足被发现是术后并发症的重要危险因素。
结论:为了治疗不稳定的PHF,使用至少一个MSS以及锁定板系统足以实现令人满意的结果。使用锁定钢板进行PHF治疗的成功手术治疗在解剖骨折复位中是固有的。加上中间柱支撑。
BACKGROUND: The calcar of the proximal humerus is a fundamental structure for medial humeral column support. This study aimed to assess the outcome of osteosynthesis across cases of unstable proximal humerus fractures (PHFs) with medial calcar comminution, following treatment with a PHILOS locking plate and medial support screw (MSS).
METHODS: Between January 2010 and December 2018, we retrospectively analyzed the outcomes of 121 cases of osteosynthesis for PHFs with medial column disruption. For the medial support, at least one oblique screw was inserted within 5 mm of the subchondral bone in the inferomedial quadrant of the humeral head. All patients were categorized into two groups: 26 patients in the single MSS group, and 95 in the multiple MSS group. Follow-up after at least an year involved clinical and radiographic outcome evaluations, and correspondingly measuring the Constant-Murley score, University of California, Los Angeles (UCLA) shoulder scale, pain visual analogue scale (VAS), major complications, neck-shaft angle (NSA), humeral head height (HHH), and the eventual time to bone union. Risk factors for the major complications were assessed by multivariate logistic regression analyses.
RESULTS: The cohort\'s mean age was 64.4 ± 15.4 years, and the mean follow-up duration was 19.5 ± 7.6 months. At the final follow-up, between the single MSS and multiple MSS groups, no significant differences in the Constant-Murley score (p = 0.367), UCLA score (p = 0.558), VAS (p = 0.571), time to bone union (p = 0.621), NSA loss (p = 0.424), and HHH loss (p = 0.364) were observed. The incidence of complications (p = 0.446) based on the number of MSS were not significantly different. The initial insufficient reduction after surgery (of NSA < 125°) was found to be a significant risk factor for post-surgical complications.
CONCLUSIONS: To treat unstable PHFs, the use of at least one MSS along with a locking plate system is sufficient to achieve satisfactory outcomes. Successful operative treatment using a locking plate for PHF treatment is inherent in anatomical fracture reduction, coupled with medial column support.