老年肱骨近端骨折锁定钢板固定同种异体骨移植

Locking plate combined with fibular allograft augmentation for proximal humeral fractures in the elderly

摘要:

[目的]比较锁定钢板联合同种异体腓骨段与骨颗粒移植治疗老年人 Neer 3、4 部分肱骨近端骨折伴压缩性骨缺损的临床疗效。[方法] 回顾性研究 2012 年 1 月—2019 年 12 月接受肱骨近端锁定钢板内固定联合同种异体骨移植治疗的 66 例老年肱骨近端骨折压缩性骨缺损患者的临床资料。其中，31 例采用同种异体腓骨移植 (骨段组)，35 例采用同种异体颗粒移植 (骨粒组)。比较两组围手术期、随访与影像资料。[结果] 两组患者均顺利完成手术，两组手术时间、透视次数、术中出血量、切口愈合等级及住院时间方面的差异均无统计学意义(P＞0.05)。随访时间至少 12 个月，两组恢复主动活动时间和完全负重活动时间的差异无统计学意义(P＞0.05)。与术后 6 个月相比，术后 12 个月时两组的 Constant-Murley 评分、ASES 评分、前屈上举活动度及外展上举活动度均显著增加(P＜0.05)。相应时间点，两组间上述指标的差异均无统计学意义(P＞0.05)。影像检查显示两组骨质复位质量及骨折愈合时间的差异均无统计学意义 (P＞0.05)。骨段组的颈干角改变值 (variation of neck-shaft angle, VNSA)和肱骨头高度改变值(variation of humeral head height, VHHH)均显著小于骨粒组(P＜0.05)。[结论]采用锁定钢板治疗老年人肱骨近端 Neer 3、4 部骨折，联合同种异体腓骨段植骨或颗粒骨植骨的临床疗效无明显差别，但腓骨段移植可更好地维持肱骨颈干角和肱骨头高度。

Abstract:

[Objective] To compare the clinical outcomes of locking plate combined with fibular strut allograft versus granular bone al- lograft for Neer three- and four-part proximal humeral fractures complicated with compressive bone defect in the elderly. [Methods] A ret- rospective study was conducted on 66 elderly patients who received locking plate combined with bone allografting for proximal humeral frac- tures complicated with compressive bone defect in our hospital from January 2012 to December 2019. Among them, 31 patients received fibular strut allograft, while the remaining 35 received granular bone allografts. The two groups were compared regarding to perioperative, follow-up, and radiographic data. [Results] All patients in both groups had surgical procedures finished successfully without statistical dif- ferences between the two groups in terms of operation time, intraoperative fluoroscopic frequency, blood loss, incision healing and hospital stay (P＞0.05) , and followed up for more than 12 months. At 12 months postoperatively, the Constant-Murley score (CMS) , American Shoul- der and Elbow Surgeons (ASES) score, forward flexion range of motion (ROM) , and abduction ROM of the shoulder were significantly im- proved in both groups compared with those at 6 months postoperatively (P＜0.05) , whereas which proved not statistically significant be- tween the two groups at any matching time points (P＞0.05) . Radiographically, although there were no significant differences in term of frac- ture reduction quality and fracture healing time on images between the two groups (P＞0.05) , the strut group proved significantly superior to the granular group in terms of variation of neck-shaft angle (VNSA) and variation of humeral head height (VHHH) (P＜0.05) . [Conclusion] The locking plate combined with both strut bone allografting and granular bone allografting does achieve similar satisfactory clinical out- comes for Neer 3- or 4-part proximal humeral fractures complicated with compressive bone defect in the elderly. However, the fibular strut allograft has a better capacity to maintain the NSA and HHH.