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首页> 外文期刊>The Journal of Bone and Joint Surgery. American Volume >Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures (corrected)
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Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures (corrected)

机译：肱骨近端骨折经切开复位复位钢板固定后的骨折移位和螺钉切开（校正）

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BACKGROUND: Fixation of proximal humeral fractures is challenging. Locking plate technology offers mechanical advantages for treating unstable fractures in weak bone. In this study, we assessed the radiographic and clinical results of a single surgeon's experience treating proximal humeral fractures with a locked proximal humeral plate. METHODS: Fifty-three adult patients with a displaced proximal humeral fracture were treated with a proximal humeral locking plate over a forty-five-month period. A standard postoperative rehabilitation regimen was followed. Radiographs were made at two weeks, six weeks, three months, six months, and one year and were examined for fracture alignment, fracture displacement, hardware position, and healing. Postoperative outcomes were collected with questionnaires. RESULTS: Fifty-two (98%) of the fifty-three fractures healed by six months. Nineteen patients (36%) had radiographic signs of a complication, including screw cutout with intra-articular displacement in twelve (23%), substantial (>10 degrees ) varus displacement in thirteen (25%), and osteonecrosis in two (4%). These radiographic signs of a complication occurred in twelve (57%) of twenty-one patients older than sixty years of age and in seven (22%) of thirty-two patients under sixty years of age (p = 0.0015). Screw cutout occurred in nine (43%) of the twenty-one patients older than sixty years. Patients with a complication had worse functional outcomes as measured with the Short Musculoskeletal Function Assessment (p < 0.05) and the Quick Disabilities of the Arm, Shoulder and Hand (p < 0.001) questionnaires. We were unable to demonstrate a relationship between fracture type and complications. Revision surgery was performed in seven (13%) of the fifty-three patients. There were no cases of infection, nerve injury, or hardware failure. CONCLUSIONS: The use of locking plates in the surgical treatment of proximal humeral fractures is associated with an unexpectedly high rate of screw cutout and revision surgery, especially in patients older than sixty years who have a three or four-part fracture. The indications for open reduction and internal fixation in these patients require continued analysis.
机译：背景：肱骨近端骨折的固定具有挑战性。锁定板技术具有机械优势，可用于治疗弱骨不稳定骨折。在这项研究中，我们评估了单名外科医生用锁定的肱骨近端钢板治疗肱骨近端骨折的放射学和临床结果。方法：53例成人肱骨近端移位骨折患者接受了肱骨近端锁定板治疗，历时四十五个月。遵循标准的术后康复方案。分别在两周，六周，三个月，六个月和一年进行X射线照相，并检查其骨折排列，骨折移位，硬体位置和愈合情况。术后结果通过问卷收集。结果：53个骨折中的52个（98％）治愈了六个月。 19位患者（36％）的影像学表现为并发症，包括十二指肠螺钉移位伴关节内移位（23％），十三内翻（> 10度）内翻移位（25％）和两例骨坏死（4％） ）。这些并发症的放射学征象发生在二十一名六十岁以上的患者中的十二名（57％）和六十二岁以下的三十二名患者中的七名（22％）（p = 0.0015）。 21名年龄超过60岁的患者中有9名（43％）发生了螺钉切开术。根据短期肌肉骨骼功能评估（p <0.05）和手臂，肩膀和手部快速残疾（p <0.001）问卷调查，并发症患者的功能结局较差。我们无法证明骨折类型与并发症之间的关系。五十三名患者中有七名（13％）进行了翻修手术。没有感染，神经损伤或硬件故障的情况。结论：在肱骨近端骨折的手术治疗中使用锁定板与意外的高螺钉切开和翻修手术相关，特别是对于六岁以上三或四部分骨折的患者。这些患者的切开复位和内固定的适应症需要继续分析。

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