锁定钢板治疗肱骨近端骨折中肱骨颈干角重建对疗效影响的研究

EFFECT OF DIFFERENT NECK-SHAFT ANGLE ON EFFICACY IN TREATMENT OF PROXIMAL HUMERAL FRACTURES WITH LOCKING PLATE

目的 探讨锁定钢板治疗肱骨近端骨折中肱骨颈干角重建程度对疗效的影响。方法 回顾分析2009年3月-2013年3月,106例采用锁定钢板治疗的肱骨近端骨折患者临床资料。男58例,女48例;年龄26～71岁,平均52.3岁。致伤原因：交通事故伤54例,高处坠落伤23例,摔伤21例,其他伤8例。根据Neer分型标准：二部分骨折32例,三部分骨折65例,四部分骨折9例。受伤至手术时间1～7 d,平均2.7 d。根据术后1～3 d X线片测量的肱骨颈干角,将患者分为3组进行影像学以及临床疗效比较。其中术后肱骨颈干角〉145°为外翻组,126～145°为正常组,〈126°为内翻组。结果 根据术后肱骨颈干角分组,外翻组10例,正常组75例,内翻组21例;3组患者一般资料比较,差异均无统计学意义（P〉0.05）。患者术后均获随访,随访时间6～12个月。X线片复查,3组骨折愈合时间比较差异无统计学意义（P〉0.05）。术后6个月正常组肱骨头内翻角、疼痛视觉模拟评分（VAS）显著低于内、外翻组（P〈0.05）。正常组Constant-Murley评分优良率为78.67%（59/75）,显著高于外翻组60.0%（6/10）以及内翻组42.86%（9/21）（P〈0.05）;内、外翻组间比较,差异无统计学意义（P〉0.05）。内翻组并发症发生率为28.57%（6/21）,正常组为10.67%（8/75）,外翻组为20.00%（2/10）,比较差异无统计学意义（χ2=4.31,P=0.12）。结论 肱骨近端骨折术中肱骨颈干角正常重建是术后肩关节功能恢复的关键因素。

Objective To observe the influence of different humeral neck-shaft angle on the efficacy in the treatment of proximal humeral fractures with locking plate. Methods A total of 106 patients with proximal humeral fractures were treated by locking plate between March 2009 and March 2013, and the clinical data were retrospectively analyzed. Of 106 cases, 58 were male and 48 were female, aged from 26 to 71 years （mean, 52.3 years）. The causes were traffic accident injury in 54 cases, falling injury from height in 23 cases, falling injury in 21 cases, and others in 8 cases. According to the Neer classification, there were 32 cases of two-part fractures, 65 cases of three-part fractures, and 9 cases of four-part fractures. The time from injury to operation was 1-7 days （mean, 2.7 days）. According to neck-shaft angle by X-ray measurements at 1-3 days after operation, the patients were divided into 3 groups： valgus group （〉145~）, normal group （126-145~）, and varus group （〈126~） to observe the influence of neck-shaft angle on efficacy. Results According to postoperative humeral neck-shaft angle, there were 10 cases in valgus group, 75 cases in normal group, and 21 cases in varus group. There was no significant difference in general clinical data among 3 groups （P〉0.05）. The patients were followed up 6-12 months. The X-ray results showed fracture healing, and no significant difference was found in fracture healing time among 3 groups （P〉0.05）. After 6 months, the varus angle of femoral head and visual analogue scale （VAS） score of normal group were significantly lower than those of valgus group and varus group （P〈0.05）. The excellent and good rate of Constant-Murley score was 78.67% （59/75） in normal group, and it was significantly higher than that in valgus group （60.00%, 6/10） and varus group （42.86%, 9/21） （P〈0.05）, but there was no significant difference between valgus group and varus group （P〉0.05）. The complication rate was 28.57% （6/21） in varus group, was 10.67% （8/75） in normal group, and was 20.00% （2/10） in valgus group, showing no significant difference among 3 groups （X2=4.31,P=0.12）. Conclusion Reconstruction of normal neck-shaft angle is the key to good shoulder function and clinical efficacy in the treatment of proximal humeral fracture.