Nonunions of the proximal humerus: Their prevalence and functional outcome
Nonunions of the proximal humerus: Their prevalence and functional outcome
复制标题
DOI：
10.1097/ta.0b013e3181469840
复制
发表时间：
2008-06-01
影响因子：
--
通讯作者：
McQueen, Margaret M.
中科院分区：
文献类型：
--
作者：
Court-Brown, Charles M.;McQueen, Margaret M.
背景我们分析了肱骨近端不愈合的患病率并评估了其功能结果。方法：分析了一项研究的结果，该研究的11例肱骨近端骨不连来自先前对1，027例连续肱骨近端骨折的前瞻性研究，以确定患者人群的人口统计学、6周、13周、26周时的Constant和Neer评分，术后1年及术后功能恢复情况。所有患者均随访1年，每次评估时均拍摄标准前后位和改良轴位X线片。与近端骨不连相关的可能因素进行了study.Results：近端肱骨骨不连的患病率为1.1%，虽然它上升到约8%，如果干骺端粉碎存在和10%，如果有33%和100%之间的平移的手术颈。骨不连对功能的影响是相当大的，甚至早在骨折后6周。我们的研究结果显示，与骨折愈合的患者相比，6个月后整体盂肱功能恶化。骨不连患者恢复日常生活能力明显较慢。结论：我们的研究结果表明，肱骨近端骨折非手术治疗后的骨不连比以前报道的要少得多，他们认为年龄，干骺端粉碎和骨折移位都是骨不连发生的因素。他们还指出，如果肱骨近端骨不连需要手术治疗，则不应延迟至骨折后6个月以上，理想情况下应在确定存在骨不连后立即进行，通常在骨折后3个月左右。
Background. We present an analysis of the prevalence of proximal humeral nonunions and an assessment of their functional outcome.Methods: The results of a study of 11 proximal humeral nonunions taken from a previous prospective study of 1,027 consecutive proximal humeral fractures were analyzed to determine the demography of the patient population, the Constant and Neer scores at 6 weeks, 13 weeks, 26 weeks, and 1 year and the functional outcome of the patients. All patients had been followed for 1 year and standard anteroposterior and modified axial X-rays taken at each assessment. The possible factors associated with proximal nonunion were studied.Results: The prevalence of proximal humeral nonunion is 1.1%, although it rises to about 8% if metaphyseal comminution is present and 10% if there is between 33% and 100% translation of the surgical neck. The effect of nonunion on function is considerable, even as early as 6 weeks after fracture. Our results show a deterioration of overall glenohumeral function after 6 months compared with patients whose fractures unite. Return to routine activities of daily living is markedly slower in the presence of a nonunion. The nonunions occurred in older patients but the age difference was not statistically significantConclusions: Our results show that nonunion after nonoperative treatment of proximal humeral fractures is much less than has previously been reported and they suggest that age, metaphyseal comminution and fracture displacement are all factors in the development of nonunion. They also indicate that if operative treatment is required for proximal humeral nonunion it should not be delayed beyond 6 months after fracture and ideally should be performed as soon as the presence of a nonunion has become established this frequently being about 3 months after fracture.