肱骨近端骨折PHILOS钢板固定术后影响肩关节功能的相关因素

Related factors on shoulder function recovery after PHILOS plate fixation of proximal humeral fracture

目的分析肱骨近端骨折PHILOS钢板内固定术后影响肩关节功能恢复的相关因素。方法回顾性分析上海中医药大学附属第七人民医院骨伤科于2014年7月至2016年6月间收治的77例肱骨近端骨折患者的临床资料,记录术后1年随访时患者的肩关节NEER评分,其中80～100分为优良,79分以下为可差。对影响患者NEER评分的因素(包括年龄、性别、骨质疏松、中医证型、骨折分型、受伤至手术时间、肩袖损伤、手术入路、复位质量、内固定取出等)进行单因素及Logistic回归分析。结果单因素分析结果表明,年龄<50岁者NEER评分优良率为90.0%,骨质疏松1～3级为89.47%,中医证型为气滞血瘀者85.42%,NEERⅡ骨折分型者为90.48%、无肩袖损伤者90.24%、复位质量满意者89.06%,以上因素均与NEER评分优良率有关(P<0.05);Logistic回归分析结果表明,年龄、骨质疏松、中医证型、骨折分型、肩袖损伤和复位质量是PHILOS钢板治疗肱骨近端骨折术后影响肩关节功能的主要因素(P<0.05)。结论肱骨近端骨折术中应注意骨折复位和修补肩袖,术后可根据证型辨证论治,采用中西医结合治疗和康复。

Objective To analyze the related factors on the recovery of shoulder function after PHILOS plate fixation of proximal humeral fracture.Methods The clinical data of 77 patients with proximal humeral fractures,who were treated by PHILOS plate fixation and admitted to Department of Orthopedics of Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from July 2014 to June 2016,were retrospectively analyzed. The NEER score of shoulder joint at one-year follow-up was recorded.Among them,80-100 score was excellent and good,and below 79 was poor.Univariate and logistic regression analysis was performed on the factors influencing NEER score (including age,sex,osteoporosis,TCM syndrome,fracture classification,time from injury to operation,rotator cuff injury,surgical approach,reduction quality,removal of internal fixation).Results Univariate analysis showed that,the excellent and good rate of NEER score was 90.0% in the patients under 50 years old,89.47% in the osteoporosis grade 1-3,85.42% in the patients with qi stagnation and blood stasis,90.48% in the patients with NEER Ⅱ fracture, 90.24% in the patients without rotator cuff injury and 89.06% in the patients with satisfactory reduction quality,and all the above factors were related to the excellent and good rate of NEER score (P<0.05).Logistic regression analysis showed that Chinese and Western medicine factors influencing shoulder joint function after PHILOS plate treatment for proximal humeral fractures included age,osteoporosis,TCM syndrome,fracture classification,rotator cuff injury and reduction quality (P<0.05).Conclusion For proximal humeral fracture,reduction should be well controlled,and the rotator cuff should be repaired during the operation.The treatment and rehabilitation after operation should be based on the TCM syndrome of differentiation.