A novel cement-reinforced screw combined with locking plate fixation versus humeral head arthroplasty in the treatment of osteoporotic fractures of the proximal humerus / 中国组织工程研究

ABSTRACT

BACKGROUND: To solve the complications such as screw cut-out, loosening, and insufficient holding force that may occur during internal fixation of osteoporotic fractures, a new cement-reinforced screw combined with PHILOS plate is currently used to treat osteoporotic fracture of the proximal humerus. However, there are few reports on the clinical efficacy of this technique in the treatment of osteoporotic fractures of the proximal humerus in China. OBJECTIVE: To compare the clinical efficacy of a novel cement-reinforced screw combined with locking plate fixation and artificial humeral head replacement in the treatment of osteoporotic fractures of the proximal humerus. METHODS: Twenty-two patients with osteoporotic fractures of the proximal humerus admitted to at Guizhou Provincial People’s Hospital from February 2017 to March 2019 were enrolled, including 8 males and 14 females, aged 68-88 years. Ten patients underwent open reduction using new cement-reinforced screws combined with locking plate internal fixation (internal fixation group), and 12 patients underwent humeral head arthroplasty (humeral head arthroplasty group). The operation time, intraoperative blood loss, and intraoperative and postoperative complications were compared. The Visual Analogue Scale and Constant scores of the shoulder joint were detected at 6 months after surgery. All patients received a postoperative anti-osteoporosis treatment. The study was approved by the Ethics Committee of Guizhou Provincial People’s Hospital, approval No. 2017(02). RESULTS AND CONCLUSION: (1) Twenty-two patients were followed up for 6-15 months, an average of (9.0±1.6) months. (2) No toxicity reaction of bone cement or embolism occurred in both groups. One case of postoperative shoulder stiffness occurred in the internal fixation group. There were no complications in both groups, such as incision infection, heterotopic ossification, delayed healing, and screw cut-out. (3) The operation time and intraoperative blood loss in the internal fixation group were significantly less than those in the humeral head arthroplasty group (P 0.05). (5) In summary, the novel cement-reinforced screw technique combined with locking plate internal fixation has similar clinical efficacy with humeral head arthroplasty. Therefore, this new technique is an alternative internal fixation method for some patients scheduled for shoulder joint arthroplasty.