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首页> 外文期刊>Injury >Prediction of outcome after humeral diaphyseal fracture.
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Prediction of outcome after humeral diaphyseal fracture.

机译：肱骨干phy端骨折后预后的预测。

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PURPOSE: The aim of this study is to examine the demographic factors, functional outcome and radiological data to predict the outcome of humeral diaphyseal fractures. METHODS: We performed a prospective study on a consecutive series of 110 patients of 16 years or over, who had sustained a humeral diaphyseal fracture. There were 42 males and 68 females, with an average age of 59 years (range 16-93 years). A total of 72% sustained low-energy injuries, and 89 patients (81%) were primarily treated non-operatively. Shoulder function was assessed using the Neer's and Constant's scores at 8 weeks, 3 months, 6 months and 1 year after injury. Muscle strength was determined isokinetically using a Biodex System 2 dynamometer. Non-union was defined as a failure to bridge at least three cortices and persistence of tenderness or mobility at the fracture site 16 weeks after fracture. RESULTS: Sixteen patients (17%) had non-union at 16 weeks, while 80 had achieved union and a further 14 were lost to follow-up. After stepwise multiple linear regression was performed to isolate independent factors affecting outcome, only the presence of a proximal diaphyseal fracture was found to predict non-union along with a poor Neer's score at 8 and 12 weeks. Poor Neer's scores could be predicted at 26 weeks by age (P<0.05), previous stroke (P<0.001) and non-union (P<0.001). At 52 weeks both age (P<0.01) and previous stroke (P<0.01) were independently predictive of poorer Neer's scores. Malunion of any degree had no detectable effect on function. CONCLUSIONS: Our results indicate that non-union of humeral diaphyseal fractures can be predicted in the presence of a proximal third fracture with a Neer's score of less than 45 by 12 weeks after fracture. Early surgery improves early function, but this is not a lasting effect. Poor shoulder function is predicted by increasing age, proximal third fractures and non-union. We recommend that surgery to promote union be considered at 12 weeks after fracture in fit patients with fractures of the proximal third of the humerus, poor Neer's scores and no radiographic progression to union.
机译：目的：本研究的目的是检查人口统计学因素，功能预后和放射学数据，以预测肱骨干phy端骨折的预后。方法：我们对连续的110例16岁以上的肱骨干dia端骨折患者进行了一项前瞻性研究。男42例，女68例，平均年龄59岁（范围16-93岁）。共有72％的患者遭受了低能量损伤，其中89例（81％）患者主要接受了非手术治疗。在受伤后8周，3个月，6个月和1年时，使用Neer's和Constant评分对肩部功能进行评估。使用Biodex System 2测功机等速测定肌肉强度。骨折不愈合的定义是骨折后16周未能桥接至少三个皮质，并且在骨折部位持续存在压痛或活动性。结果：16例患者（17％）在16周时不愈合，而80例达到了愈合，另外14例失去了随访。在进行逐步多元线性回归分析以分离出影响预后的独立因素后，仅发现近端干端骨折的存在可预测8周和12周时不愈合以及Neer评分较差。 Neer评分低可预测在26周时的年龄（P <0.05），先前的中风（P <0.001）和不愈合（P <0.001）。在52周时，年龄（P <0.01）和以前的卒中（P <0.01）均独立预测较差的Neer评分。任何程度的残骸对功能均无可检测的影响。结论：我们的结果表明，肱骨干12端骨折的不愈合可以在骨折后12周内发现第三骨近端且Neer评分小于45的情况下进行。早期手术可改善早期功能，但这不是持久的作用。肩部功能不佳可通过增加年龄，近端第三骨折和不愈合来预测。我们建议对于肱骨近端三分之一骨折，Neer评分较差且无影像学进展为合并症的合适患者，在骨折后第12周考虑手术以促进合并。

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