肱骨近端骨折锁定钢板内固定术后影响肩关节功能的相关因素分析

Influencing factors on shoulder function recovery after locking plate fixation of proximal humeral fractures

[目的]探讨影响肱骨近端骨折经锁定钢板内固定治疗术后肩关节功能恢复的相关因素。[方法]对本院2011年1月-2013年12月收治的177例肱骨近端骨折患者,均采用锁定钢板内固定治疗,术后1年随访时评价患者的肩关节功能恢复情况,并对患者年龄、性别、骨密度、骨折类型、受伤至手术时间、内固定取出时间、术后开始功能锻炼康复时间和复位质量等相关影响因素进行Logistic回归分析。[结果]经18-36个月的随访,影响肱骨近端骨折经锁定钢板内固定治疗术后肩关节功能恢复的因素有：年龄、性别、骨折分型、骨密度、复位质量、术后开始功能锻炼时间。[结论]复位质量是术中的可控因素,因此术中应尽量复位满意,必要时可扩大切口进行复位;术后应服用治疗骨质疏松的药物。对于严重的粉碎性肱骨近端骨折,或许可选择关节置换进行治疗。

[Objective]To investigate the influencing factors for the recovery of shoulder function after locking plate fixation of proximal humeral fractures. [Method]A total of 177 patients with proximal humeral fractures admitted to our hospital from January 2011 to December 2013 were treated by locking plate fixation. The recovery of their shoulder function was evaluated at one year after operation. Logistic regression analysis was performed to assess possible influencing factors,such as age,sex,bone mineral density（ BMD）,type of fracture,time from injury to surgery,time to removal of internal fixation,postoperative time to functional exercises,and reduction outcome. [Result]The 18- 36 months of follow- up showed that the influencing factors for the recovery of shoulder function after locking plate fixation of proximal humeral fractures were age,sex,type of fracture,BMD,reduction outcome,and postoperative time to functional exercises. [Conclusion]Reduction should be well controlled during the internal fixation of proximal humeral fractures to achieve a good outcome,and open reduction is performed if necessary; the drugs for osteoporosis should be given after surgery. For comminuted proximal humeral fractures,joint replacement may be a more ideal treatment.