Minimally invasive plate osteosynthesis in proximal humeral fractures: one-year results of a prospective multicenter study
Minimally invasive plate osteosynthesis in proximal humeral fractures: one-year results of a prospective multicenter study
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DOI：
10.1007/s00264-015-3069-z
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发表时间：
2016-03-01
影响因子：
2.7
通讯作者：
Necozione, Stefano
中科院分区：
文献类型：
--
作者：
Falez, Francesco;Papalia, Matteo;Necozione, Stefano
目的-本多中心研究的目的是评估结果微创钢板接骨术（MIPO）肱骨近端骨折的术后肩关节功能，影像学结果和并发症的数量。方法一个连续的系列76例肱骨近端骨折采用锁定钢板微创前外侧入路在两个骨科。74例患者随访1年，Constant评分和影像学评估的功能结果可用于患者的平均Constant评分为71（范围28-100）。还对两个中心的每个功能结果进行了评价，无显著差异。只有年轻患者的结果更好，才有显著的统计学差异（p < 0.05）。20例患者（27%）出现并发症。肩峰下撞击发生在16.2%的内翻复位不良（6.7%）和钢板定位太近（9.5%）病例中。初次螺钉穿孔（2.7%），由于切出导致继发穿孔肱骨头缺血性坏死（AVN）1.4%（1.4%），大结节部分吸收（2.7%），继发性大结节脱位（2.7%）和刚度（2.7%）结论MIPO技术治疗肱骨近端骨折是安全的，对于大多数常见的骨折类型，骨折由于保留了软组织、三角肌和旋支血管，易于进入棒区域以正确定位接骨板，因此重大并发症发生率明显较低。
Purpose The aim of this multicentric study was to evaluate results of minimally invasive plate osteosynthesis (MIPO) for proximal humeral fractures in terms of postoperative shoulder function, radiological outcome and number of complications.Methods A consecutive series of 76 patients with proximal humeral fractures were treated with locking plate using a minimally invasive antero-lateral approach in two orthopaedic departments. Functional results with Constant score and radiographic evaluation were available for 74 patients at one-year follow up.Results The patients achieved a mean Constant score of 71 (range 28-100). Each functional result was evaluated also for both centres without significant differences. Significant statistical differences were only found for younger patients with better results (p < 0.05). Twenty patients (27 %) developed complications. Subacromial impingement occurred in 16.2 % of cases for varus malreduction (6.7 %) and for too proximal plate positioning (9.5 %). Primary screws perforation (2.7 %), secondary perforation due to cut-out (1.4 %), avascular necrosis (AVN) of humeral head (1.4 %), partial resorption of greater tuberosity (2.7 %), secondary dislocation of the greater tuberosity (2.7 %) and stiffness (2.7 %) were the other complications observed.Conclusions The MIPO technique for proximal humeral fractures was safe and reproducible for most common patterns of fracture. Major complication rate was apparently low due to a soft tissue sparing, deltoid muscle and circumflex vessels, with easy access of the bar area to correct positioning of the plate.