Deltopectoral vs. deltoid split approach for proximal HUmerus fracture fixation with locking plate: a prospective RAndomized study (HURA)

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研究概要

Eighty-five patients with proximal humerus fractures were randomized to receive plate fixation of the fracture via a deltoid split approach (n=44) or a classic deltopectoral approach (n=41). The primary outcome of interest was function measured using the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score, the Short Form-12 (SF-12) mental and physical component scales (MCS; PCS), pain scores on a Visual Analogue Scale (VAS), range of motion in external rotation and flexion, the Patient Specific Activity Scale (PSAS) for scar satisfaction, surgical outcomes (i.e., operative time and blood loss), initial fixation data (i.e., screw perforation, adequate reduction, cortex medial support, medial cortex and/or calcar screw), and the incidence of adverse events (i.e., cutout screw, nonunion, fixation failure, reduction loss, avascular necrosis, heterotopic ossification, and re-operation). The mean follow up time was 26 +/- 15 months post-operation. Results demonstrated that blood loss was statistically significantly lower in the deltoid split group compared to the deltopectoral group (144 mins vs 200 mins; p=0.017). Moreover, initial fixation data was similar between the two groups (p>0.05 for all). QuickDASH scores and VAS pain scores at final follow-up were statistically significantly in favour of the deltopectoral group compared to the deltoid split group (p<0.05 for both). No statistical significant differences in SF-12 PCS scores, range of motion in external rotation or flexion, and PSAS scar satisfaction scores were observed between the two groups (p>0.05 for all). SF-12 MCS scores were statistically significantly in favour of the deltopectoral group (p=0.049). The incidence of all complications, as well as the proportion of patients with 1 or more complications, were not statistically significantly different between the deltoid split and deltopectoral groups (p>0.05 for all).