锁定钢板治疗肱骨近端骨折的并发症分析

Complications in locking plate treating proximal humeral fractures

目的探讨应用锁定钢板治疗肱骨近端骨折的并发症原因及预防方法。方法选择自2004年9月至2007年6月收治并得到随访的92例患者，平均随访时间15．2个月（6-36个月），患者平均年龄47．7岁（17-83岁）。其中新鲜骨折78例，陈旧骨折14例，均行切开复位锁定钢板内固定。最终随访时应用美国肩肘外科医师评分（ASES）、Constant-Murley评分、加州大学洛杉矶分校评分（UCLA），以及简单肩关节功能问卷评分（SST）评估治疗结果，观察肩关节活动范围、疼痛恢复情况，记录出现并发症的情况，分析包括不同年龄、性别、伤侧、手术时间、受伤原因、合并损伤、骨折类型等出现并发症的差异性，对比出现并发症与否患者的治疗效果。结果前屈上举（148．9±17．3）°（90°～170°），外旋（29．3±15．0）°（0°-70°），内旋达到T9水平（T4-L5）。疼痛的视觉评分（VAS）为0．9±1．1（0-5）；ASES评分为86．4±13．0（52-100）；Constant-Murley评分为87．54-10．6（55-100）；UCLA评分为30．2±4．0（18-35）；SST 12个问题中回答“是”的问题平均为9．6个（4-12个）。17例患者出现术后并发症，发生率为19％。不同性别、伤侧、手术时间、受伤原因、合并损伤、骨折类型，以及内固定钢板类型之间并发症的发生率比较，差异无统计学意义；不同年龄组间比较，差异具有统计学意义（P〈0．05），其中年轻患者发生率较高，为26％，〉50岁患者的发生率为8．1％。出现并发症的患者包括UCLA评分、Constant-Murley评分和外旋范围与无并发症患者比较，差异具有统计学意义（P〈0．05）。结论锁定钢板是治疗存在明显移位的肱骨近端骨折的一种较为有效的治疗方式，但仍存在一定的并发症。由于出现并发症后功能活动会有所下降，临床应尽可能规范操作，妥善保护局部血运，争取最大限度地降低并发症的发生率。

Objective To discuss complications in locking plate treating displaced proximal humeral fractures and explore preventive methods. Methods The study involved 92 patients who were treated with open reduction and internal fixation with Locking plate from September 2004 to June 2007 and followed up for average 15.2 months （6-36 months）. There were 78 fresh fractures and 14 delayed ones. The average age of the patients was 47.7 years （ 17-83 years）. American Shoulder and Elbow Surgeons Form （ASES） score, Constant-Murley score, University of California-Los Angels scoring system （UCLA） score and Simple Shoulder Test （SST）were used to evaluate the clinical results and observe range of motion, recovery of pain and complications at the latest follow up. In the meantime, we observed the difference of complications in different age, sex, fracture side, operation time, injury causes, combined injury and fracture type and compared the clinical results between the patients with complications and those with- out. Results The average forward flexion was （ 148.9±17.3 ）° （ 90°-170°）, average external rotation up to （29.3±15.0）° （0°-70°） and average internal rotation reached T9 （T4-L5）. The mean VAS score was for （0.9±1. 1） points （0-5 points）, the mean ASES for （86.4±13.0） points （52-100 points） ,the mean Constant score for （87.5±10.6） points （55-100 points）, the mean UCLA for （30.2±4.0） points （18-35 points） and the mean positive answer of SST for 9.6 （4-12）. There were 17 patients with complications, with incidence rate of 18.5 %. As for incidence rate of complication, there was no statistical difference upon different sex, time from injury to operation, injury side, combined injury, injury cause, fracture type or fixation type. However, there was significant difference in aspect of different ages, with incidence rate of complication for 25.5% in patients younger than 50 years old and 8.1% in those older than 50 years old （P〈0.05）. Compared with non-complication group, complication group showed significant less external rotation and Constant-Murley and UCLA functional score （P〈0.05）. Conclusions Locking plate is a reliable method for displaced proximal humeral fractures, but there still exist certain complications. As complications may result in functional impairment, we should be strict with indication control and appropriate surgical technique during the whole procedure so as to reduce incidence rate of complication as possible.