Efficacy of locking compression plate systemfor treatment of senile patients with proximal humerus fractures

doi:10.3969/j.issn.1009-976X.2020.03.024

Abstract

Abstract: Objective To summarize the clinical effect of locking compression plate fixation in senile patients with proximal humerus fractures. Methods The clinical data of 49 elderly fracture patients admitted to the Fifth Affiliated Hospital （Zhuhai） of Zunyi Medical University from September 2016 to June 2019 were analyzed retrospectively. A total of 49 patients were included in this study, in whom 32 under went proximal humeral locking plate fixation and 17 will receive conservative treatment. The therapeutic effect, postoperative pain, postoperative swelling and functional recovery of shoulder joint were compared between the two groups. Results The effective rate of locking plate fixation group was （90.6%） and that of conservative treatment group was （82.4%）, the difference between the two groups was statistically significant （P<0.05）. VAS score of locking plate fixation group was lower than that of conservative group （P<0.05）, but there was no statistically significant difference between the two groups in the degree of postoperative swelling recovery （P>0.05）. Neer classification score, DASH score and CMS score of locking plate fixation group showed the recovery of shoulder function was better than that of the conservative group （P<0.05） at six-month follow-up. The complications in the locking plate fixation group were higher than those in the conservative group, but the difference was not statistically significant （P>0.05）. Conclusion Locking plate fixation has a good clinical effect in the treatment of proximal humeral fracture in the elderly, but different patients should choose operation or conservative treatment according to the specific situation.

Key words: elderly, locking plate fixation, proximal humerus fracture, shoulder joint

摘要： 目的研究在老年人中采用锁定钢板固定对肱骨近端骨折的临床效果。方法回顾性分析2016年9月~2019年6月遵义医科大学第五附属（珠海）医院收治的49例老年肱骨近端骨折患者的临床资料,其中32例接受肱骨近端锁定钢板固定手术,17例接受保守治疗。对比两组治疗效果、术后疼痛程度、肿胀程度、肩关节功能恢复情况。结果锁定钢板固定组的治疗有效率为（90.6%）,保守治疗组为（82.4%）,两组差异有统计学意义（P<0.05）;锁定钢板固定组患者术后1周的VAS评分低于保守组（P<0.05）,而术后肿胀程度恢复两组间差异无统计学意义（P>0.05）;锁定钢板固定组术后6月Neer评分、DASH评分、CMS反映的肩功能恢复均好于保守组（P<0.05）。锁定钢板固定组并发症较保守组高,但差异没有统计学意义（P>0.05）。结论锁定钢板固定术治疗老年肱骨近端骨折的临床效果良好,但不同患者应根据具体情况选择手术或保守治疗。

关键词: 锁定钢板固定, 老年, 肱骨近端骨折, 肩关节

CLC Number:

R683.41

CHEN Jun-ping, WANG Guo-shou, TAN Wei-yuan. Efficacy of locking compression plate systemfor treatment of senile patients with proximal humerus fractures[J]. Lingnan Modern Clinics in Surgery, 2020, 20(03): 371-375.

陈军平, 王国寿, 谭伟源. 锁定钢板固定对老年肱骨近端骨折的疗效分析[J]. 岭南现代临床外科, 2020, 20(03): 371-375.

References

[1] Vachtsevanos L, Hayden L, Desai AS, Dramis A.Management of proximal humerus fractures in adults[J]. World J Orthop, 2014, 5(5): 685-693.
[2] Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus[J]. J Shoulder Elbow Surg, 2009, 18(4): 612-621.
[3] Gaebler C, McQueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases[J]. Acta Orthop Scand, 2003, 74(5): 580-585.
[4] Agudelo J, Schürmann M, Stahel P, et al.Analysis of efficacy and failure in proximal humerus fractures treated with locking plates[J]. J Orthop Trauma, 2007, 21(10): 676-681.
[5] Osterhoff G, Ossendorf C, Wanner GA, et al.The calcar screw in angular stable plate fixation of proximal humeral fractures--a case study[J]. J Orthop Surg Res, 2011, 6: 50.
[6] Schumaier A, Grawe B.ProximalHumerusFractures: Evaluation and Management in the Elderly Patient[J]. Geriatr Orthop Surg Rehabil, 2018, 9: 2151458517750516.
[7] Kancherla VK, Singh A, Anakwenze OA.Management of Acute Proximal Humeral Fractures[J].J Am Acad Orthop Surg, 2017, 25(1): 42-52.
[8] Jung WB, Moon ES, Kim SK, et al.Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?[J]. BMC Musculoskelet Disord, 2013, 14: 102.
[9] Sproul RC, Iyengar JJ, Devcic Z, Feeley BT.A systematic review of locking plate fixation of proximal humerus fractures[J]. Injury, 2011, 42(4): 408-413.
[10] Bai L, Fu Z, An S, et al.Effect of Calcar Screw Use in Surgical Neck Fractures of the Proximal Humerus With Unstable Medial Support: A Biomechanical Study[J]. J Orthop Trauma, 2014, 28(8): 452-457.
[11] Egol KA, Sugi MT, Ong CC, et al.Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures[J]. J Shoulder Elbow Surg, 2012, 21(6): 741-748.
[12] Schliemann B, Wähnert D, Theisen C, et al.How to enhance the stability of locking plate fixation of proximal humerus fractures? An overview of current biomechanical and clinical data[J]. Injury, 2015, 46(7): 1207-1214.
[13] He Y, He J, Wang F, et al.Application of Additional Medial Plate in Treatment of Proximal Humeral Fractures With Unstable Medial Column: A Finite Element Study and Clinical Practice[J]. Medicine (Baltimore), 2015, 94(41): e1775.
[14] Chen H, Yin P, Wang S, et al.The Augment of the Stability in Locking Compression Plate with Intramedullary Fibular Allograft for Proximal Humerus Fractures in Elderly People[J]. Biomed Res Int, 2018, 2018: 3130625.
[15] 葛鸿庆, 郑沐欣, 管华. 锁定钢板联合异体腓骨支撑治疗老年内翻型肱骨近端骨折[J]. 中华创伤骨科杂志, 2019, 21(5): 440-442.
[16] 朱广伟,张新潮,张时超,等.半肩关节置换与肱骨近端内固定锁定系统钢板治疗老年复杂肱骨近端骨折的疗效对比[J]. 中国骨与关节杂志, 2019,8(8):593-598.
[17] Iyengar JJ, Devcic Z, Sproul RC, Feeley BT.Nonoperative treatment ofproximal humerus fractures: a systematic review[J]. J Orthop Trauma, 2011, 25(10):612-617.
[18] Ilchmann T, Ochsner PE, Wingstrand H, Jonsson K.Non-operative treatmentversus tension-band osteosynthesis in three- and four-part proximalhumeral fractures. A retrospective study of 34 fractures from two differenttrauma centers[J]. Int Orthop, 1998, 22(5):316-320.