Objective: 

To compare the clinical and radiological results of locking plate fixation with and without spine cage for the treatment of unstable proximal humeral fractures in elderly patients.

Design: 

Retrospective study.

Setting: 

Level 1 Trauma Center.

Patients/Participants: 

A total of 62 patients with a mean age of 72.68 (60–88) years were included. Thirty-nine patients were treated with only a locking compression plate (LCP group), whereas 23 patients were treated with a locking compression plate and a spine cage (SC group). The mean follow-up was 32.26 (24–46) months.

Main outcome measures: 

Radiological outcomes were assessed using the humeral head height and neck–shaft angle. The clinical results were evaluated using a visual analog scale for pain, the Constant–Murley score, the American Shoulder and Elbow score, and shoulder range of motion.

Results: 

The average radiological changes in the humeral head height and neck–shaft angle were significantly higher in the LCP group than in the SC group (P < 0.001 and P < 0.001, respectively). The final outcome scores were lower in the LCP group than in the SC group (Constant–Murley score of 73.26 vs. 78.91 [P = 0.028] and American Shoulder and Elbow score of 72.36 vs. 78.57 [P = 0.011]). The SC group showed better forward elevation (P = 0.005) and abduction (P = 0.001); however, no significant differences were observed for shoulder external or internal rotation. The number of complications was higher in the LCP group (38.5%) than in the SC group (13.0%) (P = 0.033).

Conclusions: 

For unstable proximal humeral fractures with medial comminution in elderly patients, locking plate with an SC is a reasonable option to ensure satisfactory results and lower the postoperative complications.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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脊柱笼锁板固定治疗老年患者不稳定的肱骨近端骨折疗效观察

客观的： 

比较锁定钢板固定加和不加脊柱笼治疗老年不稳定肱骨近端骨折的临床和影像学结果。

设计： 

回顾性研究。

环境： 

一级创伤中心。

患者/参与者： 

共纳入 62 名患者，平均年龄为 72.68（60-88）岁。39 名患者仅使用锁定加压钢板（LCP 组）进行治疗，而 23 名患者使用锁定加压钢板和脊柱保持架进行治疗（SC 组）。平均随访时间为 32.26（24-46）个月。

主要观察指标： 

使用肱骨头高度和颈干角评估放射学结果。使用视觉模拟疼痛量表、Constant-Murley 评分、美国肩肘评分和肩关节活动度评估临床结果。

结果： 

LCP 组肱骨头高度和颈干角的平均放射学变化显着高于 SC 组（分别为P < 0.001 和P < 0.001）。LCP 组的最终结果评分低于 SC 组（Constant-Murley 评分为 73.26 对 78.91 [ P = 0.028]，美国肩肘评分为 72.36 对 78.57 [ P = 0.011]）。SC组表现出更好的前倾（P = 0.005）和外展（P = 0.001）；然而，肩外旋或内旋没有显着差异。LCP组的并发症发生率（38.5%）高于SC组（13.0%）（P= 0.033)。

结论： 

对于老年患者不稳定的肱骨近端骨折伴内侧粉碎，采用SC锁定钢板是一种合理的选择，可确保获得满意的结果并降低术后并发症。

证据等级： 

治疗级别 III。有关证据级别的完整描述，请参见作者说明。