肱骨近端锁定加压钢板置入内固定治疗复杂肱骨近端骨折的并发症

Postoperative complications of complex proximal humeral fractures after treated with proximal humeral internal locking system plate fixation

背景:经三角肌劈开入路肱骨近端锁定加压钢板内固定治疗复杂肱骨近端骨折后存在一些并发症。目的:评价经三角肌劈开入路Philos钢板内固定治疗移位的三、四部分肱骨近端骨折相关术后并发症的发生率,并探讨其相关危险因素,提出降低相关并发症的对策。方法:回顾性分析106例移位的三、四部分骨折病例资料,应用Logistic回归分析相关因素与并发症的关系。结果与结论:81例患者获得12-30个月的随访。内固定后12个月时肩关节Constant评分平均为(76.57±4.70)分。内固定后共31例患者出现并发症(38.3%),其中肩峰撞击16例(19.8%),头干角丢失6例(7.4%),头干角丢失合并螺钉穿出关节面2例(2.5%),螺钉穿出关节面2例(2.5%),肱骨头坏死2例(2.5%),切口脂肪液化5例(6.2%)。单因素分析结果表明撞击组与无撞击组比较,大结节位置过高、钢板位置过高及Neer分型差异有显著性意义(P<0.05);头干角丢失组与未丢失组比较,年龄、内固定后内侧皮质缺损、Neer分型差异有显著性意义(P<0.05)。Logistic回归分析表明大结节位置过高、钢板位置过高及Neer分型是发生内固定后肩峰撞击的独立预测因素。内固定后内侧皮质缺损、Neer分型是发生内固定后头干角丢失的独立预测因素。

BACKGROUND： Proximal humeral internal locking system fixation for complex humeral fractures via deltoid splitting approach provides good clinical results, but certain complications still existed. OBJECTIVE： To explore the postoperative complications and the related risk factors for displaced three-part and four-part fractures of proximal humerus treated with proximal humeral internal locking system fixation via deltoid-splitting approach, and to propose the corresponding countermeasures. METHODS： 106 cases with displaced three-part and four-part fractures of proximal humerus were retrospectively analyzed. The relationship between postoperative complications and the related risk factors was analyzed with Logistic regression analysis. RESULTS AND CONCLUSION： A total of 81 patients were followed-up for 12 to 30 months. The mean Constant score at 12 months after operation was（76.57±4.70） points. The postoperative complications occurred in 31 patients（38.3%） of which impingement syndrome involved in 16 cases（19.8%）, head-shaft angle loss in six cases（7.4%）, head-shaft angle loss combined with screws cut-out in two cases（2.5%）, pure screws cut-out intwo cases（2.5%）, humeral head necrosis in two cases（2.5%）, fat liquefaction in five cases（6.2%）. Single factor analysis showed that there were significant differences in the superiorly located greater tuberosity, superiorly located plate and Neer classification between impingement group and un-impinged group（P 0.05）. There were statistically significant differences in age, postoperative medial cortical defects and Neer classification between head-shaft angle loss group and un-loss group（P 0.05）. By means of logistic regression analysis, the superiorly located greater tuberosity, superiorly located plate and Neer classification were the individual predictors for postoperative impingement syndrome; postoperative medial cortical defect and Neer classification were the individual predictors for postoperative head-shaft angle loss.