内侧柱有效支撑与肱骨近端骨折锁定钢板固定术后疗效的相关性研究

Study on the relationship between the medial column support and the effect of treatment by open reduction and internal fixation of the proximal humerus fractures

目的通过测量肱骨头高度丢失变化及对比临床疗效，分析内侧柱有效支撑与肱骨近端骨折锁定钢板固定术后疗效的相关性，探讨内侧柱有效支撑对肱骨近端骨折锁定钢板固定术的重要性。方法回顺性分析2009年6月至2012年8月采用锁定钢板治疗的66例肱骨近端骨折患者的病历资料。将所有病例根据肱骨近端骨折块有无内柱支撑分为两组。通过测量术后随访时患侧肱骨头高度丢失变化和评价术后肩关节功能，对比分析内侧柱有效支撑在骨折复位维持和患者功能恢复中的作用。结果66例患者随访时间10-18个月，平均13个月。内侧柱支撑组35例，无内侧柱支撑组31例。术中行髂骨植骨共7例，内侧柱支撑组3例，无内侧柱支撑组4例。至末次随访时所有患者均获得牢固的骨性愈合。内侧柱支撑组肱骨头高度丢失平均为（1．4±1．0）mm，无内侧柱支撑组肱骨头高度丢失平均为（6．2±3．7）mm，明显高于内侧柱支撑组，内侧柱支撑能有效地减小复位丢失程度。内侧柱支撑组Neer百分制评分，优32例、良3例，优良率为100％；无内侧柱支撑组，优25例、良1例、差5例，优良率为83．8％。内侧柱支撑组未出现明显并发症；无内侧柱支撑组（31例）中，3例出现螺钉穿出关节面，2例螺钉出现松动。3例螺钉穿出关节面的患者均行再次手术取出或更换螺钉。结论肱骨近端骨折张力侧锁定钢板并不能完全支撑肱骨头，内侧柱支撑可通过提高内侧柱机械稳定性更好地维持复位而提高术后疗效。

Objective By measuring the height loss of humeral head and combined with the clinical curative effect of the contrast, to investigate the correlation between the medial column support with locking proximal humerus plate fracture effi-cacy. Methods From June 2009 to August 2012, 70 cases with proximal humeral fractures underwent internal fixation with locking plates were retrospectively analyzed. Based on the presence of medial support, all the cases were divided into 2 groups according to the proximal humeral fracture block. By measuring the change of postoperative loss of lateral humeral head height and evaluating the shoulder function, to comparative analysis of the effect of medial column support in the recovery reduction maintenance and patient function. Results There were 66 cases access the follow-up of this study, loss of 4 cases in follow-up, with an average follow-up period of 13 months （range, 10-18）. Thirty-eight cases of medial support group loss to follow-up 3, and no medial support group 32 cases lost to follow-up 1. Intraoperative iliac bone graft in 7 cases, including 3 cases of medial sup- port and 4 cases of rio inner support. All cases achieved clinical bone healing in the last follow-up time. Medial support can ef- fectively reduce the degree of reduction and loss, and the average height loss of humerus head is 1.4ram （standard deviation. 1.0 mm）. The average height loss of humerus head is 6.2 mm （standard deviation. 3.7 mm） in no support group, which was substan-tially higher than the medial support group. The inner support group had no obvious complications, and in the absence of 31 cas-es of medial support, 3 cases showed screws wear out of the articular surface, 2 cases showed screws loose. In 3 cases of screw penetrating the articular surface were underwent two operation to remove or replace screws. In the medial support group, accord- ing to the Neer centesimal system score, the results were excellent in 32 cases, good in 3. The excellent and good rate was 100%. In the no medial support group, the results were excellent in 25 cases, good in 1, and fair in 5. The excellent and good rate was 83.8%. Conclusion Locking plate in tension side does not fuUy support the humeral head. The medial column support can ob-tain better maintenance of reduction and postoperative effect through improving the medial column mechanical stability.