上腕骨顆上骨折に対する低侵襲解剖学的ロッキングプレートとPHILOS（上腕骨近位内側ロッキングシステム）の比較：後向き研究
Ning-Jie Zhang1, Yi-Jie Chai2, Yu-Wen Jiang3
1Department of Orthopaedics, Shaoxing TCM Hospital Affiliated to Zhejiang Chinese Medical University (Shaoxing Hospital of Traditional Chinese Medicine), Zhejiang, China.
Background:
Locking plate fixation is an effective treatment for greater tuberosity (GT) fractures. This study aimed to compare the clinical and radiological outcomes between a low-profile anatomical locking plate (LPALP) and the proximal humeral internal locking system (PHILOS) for displaced split-type GT fractures.
Methods:
Between May 2017 and October 2023, 43 patients, followed for at least 12 months, with split-type GT fractures fixed with a PHILOS or LPALP were included. In this retrospective study, we compared the clinical and radiological outcomes of the two groups, assessed using operation time, incision size, blood loss, implant cost, duration of hospital stay, the Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant-Murley (CM) score, visual analogue scale (VAS), "GT to head height", secondary displacement of the GT, secondary operation, complications, and patient satisfaction with cosmetic appearance.
Results:
There were 18 patients in the PHILOS group and 25 patients in the LPALP group. Implantation of the PHILOS required a significantly longer operation time (82.4 ± 8.3 vs. 54.5 ± 7.9 min, P < 0.001), larger incision (9.1 ± 0.6 vs. 5.1 ± 0.4 cm, P < 0.001), and longer duration of hospital stay (8.2 ± 1.7 vs. 7.0 ± 1.3 days, P = 0.016) than the LPALP. The PHILOS implant also cost significantly more (15,950 ± 630.8 vs. 13,460 ± 346.4 RMB, P < 0.001) and involved greater blood loss (102.8 ± 10.9 vs. 52.8 ± 9.8 mL, P < 0.001) than the LPALP. No significant difference was observed between the two groups with respect to the "GT to head height", bone union time, secondary displacement of the GT, VAS scores, or incidence of complications. The CM score (91.1 ± 6.8 vs. 83.6 ± 11.3 points, P = 0.010) and DASH score (7.8 ± 5.0 vs. 13.6 ± 10.0 points, P = 0.024) were both significantly better in the LPALP group compared with the PHILOS group. In addition, patients in the LPALP group were more satisfied with the cosmetic appearance (92.0% vs. 55.6%, P = 0.009) and required a lower rate of secondary operation (0.0% vs. 22.2%, P = 0.024) than the PHILOS group.
Conclusions:
LPALP fixation for displaced split-type GT fractures was associated with a shorter surgical time, smaller incision, reduced blood loss, lower implant costs, better cosmetic and functional outcomes, and a lower reoperation rate compared with PHILOS fixation.
