Clinical outcomes of three- or four-part complex proximal humerus fractures: hemiarthroplasty versus locking plate fixation

doi:10.3969/j.issn.2095-4344.0228

Abstract

Abstract:

BACKGROUND: There is controversy over the choice of hemiarthroplasty or locking plate fixation for the treatment of three- or four-part complex proximal humerus fractures.

OBJECTIVE: To compare the clinical outcomes and difference between hemiarthroplasty and locking plate fixation in the treatment of three- or four-part complex proximal humerus fractures

METHODS: Clinical data of 73 patients with three or four parts complex proximal humerus fractures were retrospectively analyzed. 22 cases underwent hemiarthroplasty, and 51 cases received locking proximal humeral plate fixation. The preoperative data, surgery-related indicators, postoperative complications and shoulder Constant-Murley score were analyzed and compared between the two groups.

RESULTS AND CONCLUSION: (1) Totally 73 patients were followed up for 6 to 24 months. (2) Compared with the hemiarthroplasty group, the operation time was longer; the postoperative drainage volume increased and the hemoglobin decreased significantly in the locking plate fixation group (P < 0.05). (3) The overall complication rate (35%) in the locking plate fixation group was higher than that in the hemiarthroplasty group (23%), but no significant difference was found. (4) The total Constant-Murley score in the locking plate group was significantly higher than that in the hemiarthroplasty group in final follow-up post operation (P < 0.05). (5) In three-part fractures patients, Constant-Murley score was significantly higher in the locking plate fixation group than in the hemiarthroplasty group (P < 0.05). Operation time was longer and a decrease in hemoglobin level was lower in the locking plate fixation group than in the hemiarthroplasty group (P < 0.05). (6) In four-part fractures patients, no significant difference in Constant-Murley score was determined between the two groups (P > 0.05). However, operation time was longer; a decrease in hemoglobin level was lower; and in the incidence of complications was higher in the locking plate fixation group than in the hemiarthroplasty group (P < 0.05). (7) In conclusion, the shoulder joint function of overall the three- or four-part fracture of the proximal humerus fractures treated with locking plate was better than that of the hemiarthroplasty. The clinical outcome of locking plate internal fixation for the three-part proximal humerus is superior to that of hemiarthroplasty. For the four-part fracture, there is not much difference between the two treatments, but locking plate internal fixation has longer operation time, more bleeding and higher incidence of complications.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Humerus, Fractures, Bone, Prosthesis Implantation, Arthroplasty, Replacement, Tissue Engineering

CLC Number:

R318

Feng Shuo, Zha Guo-chun, Guo Kai-jin, Yang Zhi, Chang Bu-qing, Yang Shuo, Xu Chong-jun, Chen Xiang-yang. Clinical outcomes of three- or four-part complex proximal humerus fractures: hemiarthroplasty versus locking plate fixation[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(19): 2974-2980.

Figures/Tables 2

2.2 两组术前基线资料的比较锁定钢板内固定组与半肩关节的患者的性别、年龄、体质量指数及术前合并症进行比较，差异无显著性意义(P > 0.05)，2组资料具有可比性，见表1。 2.3 两组患者的临床手术指标及并发症比较锁定钢板内固定组的手术时间明显长于半肩关节置换组，差异有显著性意义(P < 0.05)。2组患者术前血红蛋白水平相比，差异无显著性意义(P > 0.05)，但术中出血量、术后引流量、术后血红蛋白量相比，2组差异均有显著性意义(P < 0.05)。在并发症方面，锁定钢板内固定组中最常见的并发症组为肱骨头缺血性坏死9例，其次是螺钉穿出6例；而在半肩关节置换组中，4例出现大小结节愈合不良。2组均无患者发生感染。锁定钢板内固定组中1例出现神经损伤，1例出现钢板断裂，1例出现术后肩关节再次脱位；这些在肩关节置换组中都未出现，仅有1例术后出现假体周围骨折。锁定钢板内固定组的总并发症发生率为35%，半肩关节置换组并发症发生率为23%，锁定钢板内固定组的总并发症发生率虽然高于半肩关节置换组，但差异无显著性意义(P > 0.05)，见表2。 2.4 按肱骨近端三、四部分骨折进行分组的临床结果比较在肱骨近端三及四部分骨折中锁定钢板内固定组的手术时间明显长于半肩关节置换组，差异有显著性意义(P < 0.05)。肱骨近端三及四部分骨折采用锁定钢板内固定血红蛋白下降量较半肩关节置换更低，二者相比差异有显著性意义(P < 0.05)。肱骨近端三部分骨折采用锁定钢板内固定与半肩关节置换在并发症方面的比较，并发症发生例数分别为5，2例，差异无显著性意义(P > 0.05)；但肱骨近端四部分骨折采用锁定钢板内固定与半肩关节置换并发症发生例数分别为13，3例，采用锁定钢板内固定的并发症发生率明显高于半肩关节置换，且差异有显著性意义(P < 0.05)。对于三部分骨折锁定钢板内固定组的患者末次随访的Constant-Murley评分明显优于半肩关节置换组，且差异有显著性意义(P < 0.05)；而四部分骨折2组患者的末次随访Constant-Murley评分差异无显著性意义(P > 0.05)，见表3。 2.5 肩关节功能Constant-Murley评分的比较末次随访锁定钢板内固定组患者的Constant-Murley总评分明显优于半肩关节置换组，差异有显著性意义(P < 0.05)。在Constant-Murley评分项目中，疼痛、日常生活活动、主动活动范围3个部分中锁定钢板内固定组患者的评分均高于半肩关节置换组，且差异有显著性意义(P < 0.05)；仅肌力评分2组差异无显著性意义(P > 0.05)，见表4。 2.6 典型病例典型病例1：女性患者，65 岁，肱骨近端4部分骨折，半肩关节置换前X射线、CT图像及随访12个月时的术后X射线见图2。典型病例2：男性患者，61 岁，肱骨近端4部分骨折，行锁定钢板内固定术前X射线、CT图像及随访12个月的术后X射线片见图3。 "

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