Marc Schnetzke, Julia Bockmeyer, Markus Loew, Stefan Studier-Fischer, Paul-Alfred Grützner, Thorsten Guehring
{"title":"肱骨近端骨折脱位后缺血性坏死的发生率:手术时机。","authors":"Marc Schnetzke, Julia Bockmeyer, Markus Loew, Stefan Studier-Fischer, Paul-Alfred Grützner, Thorsten Guehring","doi":"10.1007/s11678-018-0452-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Avascular necrosis (AVN) of the humeral head is a severe complication after proximal humerus fracture dislocations, and leads to a poorer clinical outcome and subsequent revision surgeries. The aim of the current study was to analyze the influence of time to surgery on the AVN rate after locked plating of dislocation fractures of the proximal humerus.</p><p><strong>Patients and methods: </strong>This retrospective study included 30 patients with a mean age of 63 ± 14 years with dislocation fractures of the proximal humerus type B3 or C3 according the AO/OTA classification. The rates of AVN of the humeral head were determined clinically and radiographically. In addition, the clinical outcome was determined using the Constant score (CS), the age- and sex-adjusted Constant score (CS%), Disabilities of the Arm, Shoulder, and Hand (DASH) score, the range of motion, and complication and revision rates. Patients were subdivided into groups of subjects operated on early (≤48 h after trauma) and those with late surgery (>48 h after trauma), and the relative risk (RR) for complications and revisions was determined for both groups.</p><p><strong>Results: </strong>After a mean follow-up of 37 months (range: 12-66 month) the mean CS% was 60 ± 24 and the mean DASH score was 32 ± 24 points. Ten patients (33%) developed a symptomatic AVN, and ten patients underwent revision surgery. Early surgery was performed on 25 patients while five patients underwent late surgery. After late surgery, all five patients developed AVN, and patients had a fivefold increased RR for AVN (<i>p</i> = 0.002) and subsequent associated surgical revision (RR = 3.3, <i>p</i> = 0.031).</p><p><strong>Conclusion: </strong>In fracture dislocations of the proximal humerus, early surgery within 48 h of trauma significantly decreases the risk of AVN and subsequent surgery.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"13 4","pages":"273-278"},"PeriodicalIF":0.5000,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-018-0452-6","citationCount":"30","resultStr":"{\"title\":\"Rate of avascular necrosis after fracture dislocations of the proximal humerus: Timing of surgery.\",\"authors\":\"Marc Schnetzke, Julia Bockmeyer, Markus Loew, Stefan Studier-Fischer, Paul-Alfred Grützner, Thorsten Guehring\",\"doi\":\"10.1007/s11678-018-0452-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Avascular necrosis (AVN) of the humeral head is a severe complication after proximal humerus fracture dislocations, and leads to a poorer clinical outcome and subsequent revision surgeries. The aim of the current study was to analyze the influence of time to surgery on the AVN rate after locked plating of dislocation fractures of the proximal humerus.</p><p><strong>Patients and methods: </strong>This retrospective study included 30 patients with a mean age of 63 ± 14 years with dislocation fractures of the proximal humerus type B3 or C3 according the AO/OTA classification. The rates of AVN of the humeral head were determined clinically and radiographically. In addition, the clinical outcome was determined using the Constant score (CS), the age- and sex-adjusted Constant score (CS%), Disabilities of the Arm, Shoulder, and Hand (DASH) score, the range of motion, and complication and revision rates. Patients were subdivided into groups of subjects operated on early (≤48 h after trauma) and those with late surgery (>48 h after trauma), and the relative risk (RR) for complications and revisions was determined for both groups.</p><p><strong>Results: </strong>After a mean follow-up of 37 months (range: 12-66 month) the mean CS% was 60 ± 24 and the mean DASH score was 32 ± 24 points. Ten patients (33%) developed a symptomatic AVN, and ten patients underwent revision surgery. Early surgery was performed on 25 patients while five patients underwent late surgery. After late surgery, all five patients developed AVN, and patients had a fivefold increased RR for AVN (<i>p</i> = 0.002) and subsequent associated surgical revision (RR = 3.3, <i>p</i> = 0.031).</p><p><strong>Conclusion: </strong>In fracture dislocations of the proximal humerus, early surgery within 48 h of trauma significantly decreases the risk of AVN and subsequent surgery.</p>\",\"PeriodicalId\":43682,\"journal\":{\"name\":\"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand\",\"volume\":\"13 4\",\"pages\":\"273-278\"},\"PeriodicalIF\":0.5000,\"publicationDate\":\"2018-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1007/s11678-018-0452-6\",\"citationCount\":\"30\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s11678-018-0452-6\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2018/3/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s11678-018-0452-6","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2018/3/7 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Rate of avascular necrosis after fracture dislocations of the proximal humerus: Timing of surgery.
Background: Avascular necrosis (AVN) of the humeral head is a severe complication after proximal humerus fracture dislocations, and leads to a poorer clinical outcome and subsequent revision surgeries. The aim of the current study was to analyze the influence of time to surgery on the AVN rate after locked plating of dislocation fractures of the proximal humerus.
Patients and methods: This retrospective study included 30 patients with a mean age of 63 ± 14 years with dislocation fractures of the proximal humerus type B3 or C3 according the AO/OTA classification. The rates of AVN of the humeral head were determined clinically and radiographically. In addition, the clinical outcome was determined using the Constant score (CS), the age- and sex-adjusted Constant score (CS%), Disabilities of the Arm, Shoulder, and Hand (DASH) score, the range of motion, and complication and revision rates. Patients were subdivided into groups of subjects operated on early (≤48 h after trauma) and those with late surgery (>48 h after trauma), and the relative risk (RR) for complications and revisions was determined for both groups.
Results: After a mean follow-up of 37 months (range: 12-66 month) the mean CS% was 60 ± 24 and the mean DASH score was 32 ± 24 points. Ten patients (33%) developed a symptomatic AVN, and ten patients underwent revision surgery. Early surgery was performed on 25 patients while five patients underwent late surgery. After late surgery, all five patients developed AVN, and patients had a fivefold increased RR for AVN (p = 0.002) and subsequent associated surgical revision (RR = 3.3, p = 0.031).
Conclusion: In fracture dislocations of the proximal humerus, early surgery within 48 h of trauma significantly decreases the risk of AVN and subsequent surgery.
期刊介绍：
Zielsetzung der Zeitschrift
Die Zeitschrift Obere Extremität widmet sich der Versorgung von Verletzungen, Verletzungsfolgen und Erkrankungen im Bereich des Schulter- und des Ellenbogengelenks.
Frei eingereichte Originalien präsentieren Forschungsergebnisse aktueller Studien im Bereich der Schulter- und Ellenbogenchirurgie und fördern den wissenschaftlichen Austausch. Vielversprechende Studien, die derzeit durchgeführt werden, sind ebenso willkommen, wie Langzeitstudien, die bewährte Verfahren auf den Prüfstand stellen. Fallberichte beleuchten seltene Indikationen und schildern ungewöhnliche Behandlungsverläufe.
Umfassende Übersichtsarbeiten zu einem aktuellen Schwerpunktthema sind das Kernstück jeder Ausgabe. Im Mittelpunkt steht gesichertes Wissen mit hoher Relevanz für die tägliche Arbeit in der Schulter- und Ellenbogenchirurgie. Zusätzlich wird in speziellen Rubriken über innovative Behandlungsmaßnahmen, Probleme in der Begutachtung, berufspolitische Entwicklungen und Kongressaktivitäten berichtet.
Als gemeinsames Kommunikations- und Weiterbildungsforum für alle Chirurg*innen und Orthopäd*innen mit entsprechender Spezialisierung ist die Zeitschrift Obere Extremität zukunftsorientiert und schließt eine wichtige Lücke im orthopädisch-unfallchirurgischen Informationsangebot.
Aims & scope
The journal Obere Extremität (Upper Extremity) is dedicated to the treatment of injuries, consequences of injuries and diseases in the area of the shoulder and elbow joint.
Freely submitted originals present research results of current studies in the field of shoulder and elbow surgery and promote scientific exchange. Promising studies that are currently being carried out are welcome, as are long-term studies that put proven procedures to the test. Case reports illuminate rare indications and describe unusual courses of treatment.
Comprehensive reviews on a current focus topic are the core of each issue. The focus is on secured knowledge with high relevance for the daily work in shoulder and elbow surgery. In addition, special sections report on innovative treatment measures, problems in assessment, professional policy developments and congress activities.
As a joint communication and further education forum for all surgeons and orthopaedic surgeons with appropriate specialisation, the journal Obere Extremität is future-oriented and closes an important gap in the orthopaedic trauma surgery information offer.
Begutachtung / Peer Review
Alle Beiträge, die bei der Zeitschrift Obere Extremität eingereicht werden (einschließlich der eingeladenen Manuskripte) durchlaufen ein Doppelblind-Peer-Review-Verfahren, an dem mindestens zwei unabhängige Experten beteiligt sind.---
All manuscripts submitted to the journal Obere Extremität (including invited manuscripts) undergo a double-blind peer review process involving at least two independent experts.
Ethische Richtlinien / Best Practice Guidelines and Publication Ethics
Die Zeitschrift Obere Extremität folgt den Richtlinien des Komitees für Publikationsethik (COPE). Autoren wird empfohlen, klinische Studien, die sie zur Veröffentlichung in Betracht ziehen, vor der Veröffentlichung in kostenlosen, öffentlichen Registern für klinische Studien (z.B. www.clinicaltrials.gov, http://clinicaltrials.ifpma.org, http://isrctn.org, www.germanctr.de/online-Register_de.html) zu registrieren. Die Register sind nach den Richtlinien des International Committee of Medical Journal Editors (ICMJE) zu genehmigen. Die Autor*innen sollten am Ende ihres Abstracts den Namen des Studienregisters und ihre Registriernummer für klinische Studien angeben.
The journal Obere Extremität (Upper Extremity) follows the Committee of Publications Ethics (COPE) - Guidelines. Authors are recommended to register clinical trials they consider for publication in free, public clinical trial registries (e.g., www.clinicaltrials.gov, http://clinicaltrials.ifpma.org, http://isrctn.org, www.germanctr.de/online-Register_de.html) before publication. The registries are to be approved by the guidelines of the International Committee of Medical Journal Editors (ICMJE). Authors should include the name of the trial register and their clinical trial registration number at the end of their abstract.
Deklaration von Helsinki / Declaration of Helsinki
Alle zur Veröffentlichung eingereichten Manuskripte, die Ergebnisse von Studien an Proband*innen oder Patient*innen präsentieren, müssen gemäß den Autorenrichtlinien für Originalarbeiten der Deklaration von Helsinki entsprechen.
All Manuscripts submitted for publication presenting results from studies on probands or patients must comply with the Declaration of Helsinki according to the author guidelines for original papers.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
