肱骨近端骨折通常采用切开复位钢板内固定治疗。老年患者由于骨质疏松使得螺钉锚固困难,这导致老年股骨近端骨折患者的并发症发生率和翻修率仍然很高。事实上,理想的内固定方式不仅要有足够的柔性来卸载骨–种植体界面的相互作用力,而且要有足够的生物力学强度来减少骨折断端的移动。骨水泥与钢板和其他固定技术相结合,已被提出作为骨质疏松性肱骨近端骨折治疗的替代方法。本文的目的是分析骨水泥在骨质疏松性肱骨近端骨折患者中的临床应用。 Proximal humerus fractures are usually treated with open reduction plates and internal fixation. The complication rate and revision rate in elderly patients with proximal femoral fractures remain high due to the difficulty of screw anchorage due to osteoporosis. In fact, the ideal internal fixation is not only flexible enough to release the forces at the bone-implant interface, but also biomechanical strong enough to reduce the movement of the fracture end. Bone cement, in combination with plates and other fixation techniques, has been proposed as an alternative treatment for osteoporot-ic proximal humerus fractures. The objective of this study was to analyze the clinical application of bone cement in patients with osteoporotic proximal humerus fractures.
肱骨近端骨折,骨水泥,内固定, Proximal Humeral Fractures
Bone Cement
Internal Fixation
摘要
Proximal humerus fractures are usually treated with open reduction plates and internal fixation. The complication rate and revision rate in elderly patients with proximal femoral fractures remain high due to the difficulty of screw anchorage due to osteoporosis. In fact, the ideal internal fixation is not only flexible enough to release the forces at the bone-implant interface, but also biomechanical strong enough to reduce the movement of the fracture end. Bone cement, in combination with plates and other fixation techniques, has been proposed as an alternative treatment for osteoporotic proximal humerus fractures. The objective of this study was to analyze the clinical application of bone cement in patients with osteoporotic proximal humerus fractures.
Keywords:Proximal Humeral Fractures, Bone Cement, Internal Fixation
阿更增,唐彩霞,汪庚申. 骨水泥用于治疗老年肱骨近端骨折的研究进展Research Progress in the Treatment of Proximal Humerus Fracture with Bone Cement in Elderly Patients[J]. 临床医学进展, 2023, 13(06): 9495-9501. https://doi.org/10.12677/ACM.2023.1361329
参考文献References
Patel, A.H., Wilder, J.H., Ofa, S.A., et al. (2022) Trending a Decade of Proximal Humerus Fracture Management in Older Adults. JSES International, 6, 137-143. https://doi.org/10.1016/j.jseint.2021.08.006
Rudran, B., Little, C., Duff, A., Poon, H. and Tang, Q. (2022) Proximal Humerus Fractures: Anatomy, Diagnosis and Management. British Journal of Hospital Medicine, 83, 1-10. https://doi.org/10.12968/hmed.2021.0554
Blazejak, M., Hof-mann-Fliri, L., Büchler, L., Gueorguiev, B. and Windolf, M. (2013) In Vitro Temperature Evaluation during Cement Augmentation of Proximal Humerus Plate Screw Tips. Injury, 44, 1321-1326. https://doi.org/10.1016/j.injury.2013.04.028
Brunner, F., Sommer, C., Bahrs, C., et al. (2009) Open Reduction and Internal Fixation of Proximal Humerus Fractures Using a Proximal Humeral Locked Plate: A Prospective Multicenter Analysis. Journal of Orthopaedic Trauma, 23, 163-172. https://doi.org/10.1097/BOT.0b013e3181920e5b
Gupta, A.K., Harris, J.D., Erickson, B.J., et al. (2015) Sur-gical Management of Complex Proximal Humerus Fractures-a Systematic Review of 92 Studies Including 4500 Patients. Journal of Orthopaedic Trauma, 29, 54-59. https://doi.org/10.1097/BOT.0000000000000229
Sproul, R.C., Iyengar, J.J., Devcic, Z. and Feeley, B.T. (2011) A Systematic Review of Locking Plate Fixation of Proximal Humerus Fractures. Injury, 42, 408-413. https://doi.org/10.1016/j.injury.2010.11.058
Matassi, F., Angeloni, R., Carulli, C., et al. (2012) Locking Plate and Fibular Allograft Augmentation in Unstable Fractures of Proximal Humerus. Injury, 43, 1939-1942. https://doi.org/10.1016/j.injury.2012.08.004
Sanders, R.J., Thissen, L.G., Teepen, J.C., van Kampen, A. and Jaarsma, R.L. (2011) Locking Plate versus Nonsurgical Treatment for Proximal Humeral Fractures: Better Midterm Out-come with Nonsurgical Treatment. Journal of Shoulder and Elbow Surgery, 20, 1118-1124. https://doi.org/10.1016/j.jse.2011.01.025
Schliemann, B., Siemoneit, J., Theisen, C.C., Weimann, K.A. and Raschke, M.J. (2012) Complex Fractures of the Proximal Humerus in the Elderly—Outcome and Complications after Locking Plate Fixation. Musculoskeletal Surgery, 96, 3-11. https://doi.org/10.1007/s12306-012-0181-8
Thanasas, C., Kontakis, G., Angoules, A., et al. (2009) Treatment of Proximal Humerus Fractures with Locking Plates: A Systematic Review. Journal of Shoulder and Elbow Surgery, 18, 837-844. https://doi.org/10.1016/j.jse.2009.06.004
Higgins, J.P., Thompson, S.G., Deeks, J.J., et al. (2003) Measuring Inconsistency in Meta-Analyses. BMJ, 327, 557-560. https://doi.org/10.1136/bmj.327.7414.557
Kwisda, S., Imiolczyk, J.P., Imiolczyk, T., et al. (2023) A Stand-ardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Sur-gery-Related Complications. Journal of Clinical Medicine, 12, Article 1216. https://doi.org/10.3390/jcm12031216
Gardner, M.J., Weil, Y., Barker, J.U., et al. (2007) The Importance of Medial Support in Locked Plating of Proximal Humerus Fractures. Journal of Orthopaedic Trauma, 21, 185-191. https://doi.org/10.1097/BOT.0b013e3180333094
Jung, W.B., Moon, E.S., Kim, S.-K., Kovacevic, D. and Kim, M.-S. (2013) Does Medial Support Decrease Major Complications of Unstable Proximal Humerus Fractures Treated with Locking Plate? BMC Musculoskeletal Disorders, 14, Article No. 102. https://doi.org/10.1186/1471-2474-14-102
Röderer, G., Scol, A., Schmölz, W., et al. (2013) Biomechanical in Vitro Assessment of Screw Augmentation in Locked Plating of Proximal Humerus Fractures. Injury, 44, 1327-1332. https://doi.org/10.1016/j.injury.2013.05.008
Saltzman, B.M., Erickson, B.J., Harris, J.D., Gupta, A.K., Mighell, M. and Romeo, A.A. (2016) Fibular Strut Graft Augmentation for Open Reduction and Internal Fixation of Proximal Humerus Fractures: A Systematic Review and the Authors’ Preferred Surgical Technique. Orthopaedic Journal of Sports Medicine, 4. https://doi.org/10.1177/2325967116656829
Roberts, T.T. and Rosenbaum, A.J. (2012) Bone Grafts, Bone Substitutes and Orthobiologics: The Bridge between Basic Science and Clinical Advancements in Fracture Healing. Or-ganogenesis, 8, 114-124. https://doi.org/10.4161/org.23306
Boger, A., Bohner, M., Heini, P., Verrier, S. and Schneider, E. (2008) Properties of an Injectable Low Modulus PMMA Bone Cement for Osteoporotic Bone. Journal of Biomedical Materials Research Part B: Applied Biomaterials, 86, 474-482. https://doi.org/10.1002/jbm.b.31044
Van Lieshout, E.M., Van kralingen, G.H., El-Massoudi, Y., et al. (2011) Microstructure and Biomechanical Characteristics of Bone Substi-tutes for Trauma and Orthopaedic Surgery. BMC Musculoskeletal Disorders, 12, Article No. 34. https://doi.org/10.1186/1471-2474-12-34
Jaeblon, T. (2010) Polymethylmethacrylate: Properties and Contem-porary Uses in Orthopaedics. The Journal of the American Academy of Orthopaedic Surgeons, 18, 297-305. https://doi.org/10.5435/00124635-201005000-00006
Kiaer, S. (1952) Hip Arthroplasty with Acrylic Prosthe-sis. Acta Orthopaedica Scandinavica, 22, 126-140. https://doi.org/10.3109/17453675208989000
Haboush, E.J. (1953) A New Operation for Arthroplasty of the Hip Based on Biomechanics, Photoelasticity, Fast-Setting Dental Acrylic and Other Considerations. Bulletin of the Hos-pital for Joint Diseases, 14, 242-277.
Gold, M.H. and Sadick, N.S. (2018) Optimizing Outcomes with Polymethylmethacrylate Fillers. Journal of Cosmetic Dermatology, 17, 298-304. https://doi.org/10.1111/jocd.12539
Lewis, G. (2017) Properties of Nanofiller-Loaded Poly (Methyl Methacry-late) Bone Cement Composites for Orthopedic Applications: A Review. Journal of Biomedical Materials Research Part B: Applied Biomaterials, 105, 1260-1284. https://doi.org/10.1002/jbm.b.33643
Hoess, A., López, A., Engqvist, H., Ott, M.K. and Persson, C. (2016) Comparison of a Quasi-Dynamic and a Static Extraction Method for the Cytotoxic Evaluation of Acrylic Bone Cements. Materials Science & Engineering: C, 62, 274-282. https://doi.org/10.1016/j.msec.2016.01.048
Persson, C., Robert, E., Carlsson, E., et al. (2015) The Effect of Unsaturated Fatty Acid and Triglyceride Oil Addition on the Me-chanical and Antibacterial Properties of Acrylic Bone Cements. Journal of Biomaterials Applications, 30, 279-289. https://doi.org/10.1177/0885328215581316
Katthagen, J.C., Lutz, O., Voigt, C., et al. (2018) Cement Aug-mentation of Humeral Head Screws Reduces Early Implant-Related Complications after locked Plating of Proximal Hu-meral Fractures. Obere Extremität, 13, 123-129. https://doi.org/10.1007/s11678-018-0440-x
Siebenbürger, G., Helfen, T., Biermann, N., et al. (2019) Screw-Tip Augmentation versus Standard Locked Plating of Displaced Proximal Humeral Fractures: A Retrospective Comparative Cohort Study. Journal of Shoulder and Elbow Surgery, 28, 1326-1333. https://doi.org/10.1016/j.jse.2018.12.001
Hengg, C., Nijs, S., Klopfer, T., et al. (2019) Cement Augmentation of the Proximal Humerus Internal Locking System in Elderly Patients: A Multicenter Randomized Controlled Trial. Ar-chives of Orthopaedic and Trauma Surgery, 139, 927-942. https://doi.org/10.1007/s00402-019-03142-6
Pokhvashchev, D., Knox, R., Herring, M., et al. (2023) Com-parison of Fibula Strut and Calcium Phosphate Cement Augmentation of the Medial Buttress in 2-Part Proximal Humerus Fractures Reconstruction: A Biomechanical Study. European Journal of Orthopaedic Surgery & Traumatology: Ortho-pedie Traumatologie, 33, 67-72. https://doi.org/10.1007/s00590-021-03147-1
Verona, M., Marongiu, G., Cardoni, G., Piras, N., Frigau, L. and Capone, A. (2019) Arthroscopically Assisted Reduction and Internal Fixation (ARIF) versus Open Reduction and Inter-nal Fixation (ORIF) for Lateral Tibial Plateau Fractures: A Comparative Retrospective Study. Journal of Orthopaedic Surgery and Research, 14, Article No. 155. https://doi.org/10.1186/s13018-019-1186-x
Ferguson, J., Diefenbeck, M. and Mcnally, M. (2017) Ceramic Biocomposites as Biodegradable Antibiotic Carriers in the Treatment of Bone Infections. Journal of Bone and Joint Infec-tion, 2, 38-51. https://doi.org/10.7150/jbji.17234
Robinson, C.M. and Page, R.S. (2003) Severely Impacted Valgus Proximal Humeral Fractures. Results of Operative Treatment. The Journal of Bone and Joint Surgery American Volume, 85, 1647-1655. https://doi.org/10.2106/00004623-200309000-00001
Egol, K.A., Sugi, M.T., Ong, C.C., et al. (2012) Fracture Site Augmentation with Calcium Phosphate Cement Reduces Screw Penetration after Open Reduction-Internal Fixation of Proximal Humeral Fractures. Journal of Shoulder and Elbow Surgery, 21, 741-748. https://doi.org/10.1016/j.jse.2011.09.017
Cao, K., Liu, G., Li, H., et al. (2022) Mechanical Properties and Mi-crostructure of Calcium Sulfate Whisker-Reinforced Cement-Based Composites. Materials, 15, Article 847. https://doi.org/10.3390/ma15030947
Marongiu, G., Podda, D., Mastio, M., et al. (2019) Long-Term Results of Isolated Acetabular Revisions with Reinforcement Rings: A 10- to 15-Year Follow-Up. Hip International, 29, 385-392. https://doi.org/10.1177/1120700018802750
Lee, C.W. and Shin, S.J. (2009) Prognostic Factors for Unstable Proximal Humeral Fractures Treated with Locking-Plate Fixation. Journal of Shoulder and Elbow Surgery, 18, 83-88. https://doi.org/10.1016/j.jse.2008.06.014
Liu, Z.Z., Zhang, G.M. and Ge, T. (2011) Use of a Proximal Hu-meral Internal Locking System Enhanced by Injectable Graft for Minimally Invasive Treatment of Osteoporotic Proximal Humeral Fractures in Elderly Patients. Orthopaedic Surgery, 3, 253-258. https://doi.org/10.1111/j.1757-7861.2011.00150.x
Somasundaram, K., Huber, C.P., Babu, V., et al. (2013) Proximal Humeral Fractures: The Role of Calcium Sulphate Augmentation and Extended Deltoid Splitting Approach in Internal Fixation Using Locking Plates. Injury, 44, 481-487. https://doi.org/10.1016/j.injury.2012.10.030