植骨与非植骨重建肱骨近端骨折内侧柱支撑疗效对比分析

Comparison of reconstructing medial column support of proximal humeral fracture with and without bone grafts in adult patients

目的探讨对比锁定钢板治疗肱骨近端骨折合并内侧皮质骨缺损,已获得内侧柱支撑重建时植骨与非植骨的疗效。方法收集2010-06~2016-02采用锁定钢板治疗的肱骨近端骨折46例,均完整随访。其中男28例,女18例;年龄61~92(72. 1±3. 68)岁。骨折根据Neer分型三部分骨折31例,四部分骨折15例。46例均为肱骨近端内侧粉碎性骨折且复位过程中合并该处骨缺损,将46例分为植骨组20例,非植骨组26例,两组均通过内侧支撑螺钉重建肱骨近端内侧柱支撑。对比末次随访时两组间骨折愈合时间,肩关节功能Constant评分、视觉模拟评分(VAS)、肱骨头内翻角度、并发症发生率等。结果 46例患者获得术后14~41(19. 8±2. 48)个月随访。末次随访时植骨组、非植骨组Constant评分分别为(76. 0±7. 9)分、(75. 5±6. 5)分,VAS评分分别为(2. 7±0. 8)分、(3. 1±1. 1)分,肱骨头内翻角平均分别为(0. 7±1. 2)°、(1. 2±1. 0)°,并发症发生率分别为15. 00%(3/20)、19. 23%(5/26),以上各组两两比较差异均无统计学意义(P> 0. 05)。两组间骨折愈合时间分别为(14. 6±2. 4)周、(16. 2±2. 9)周,差异有统计学意义(P <0. 05)。结论锁定钢板治疗肱骨近端骨折,当肱骨近端内侧粉碎性骨折、骨缺损或内侧骨皮质难以复位时,通过内侧支撑螺钉重建肱骨近端内侧柱支撑,无需植骨即可获得稳固的固定,达到良好的临床疗效。

Objective To explore the effects of locked plating on proximal humeral fracture complicated with the defect of medial cortical bone and to compare the reconstructing medial column support of proximal humeral fracture with and without bone grafts in adult patients. Methods The clinical data of 46 cases with proximal humeral fracture who had undergone locked plating in the First People′s Hospital of Nanning City between June 2010 and February 2016 and had been followed-up for （19.8±2.48）months averagely（14～41 months） were retrospectively analyzed. The patients included 28 males and 18 females with the age of 61～92 years old（72.1±3.68）years. The fractures were divided into two types according to Neer Classfication： three-part fractures（31 cases） and four-part fractures（15 cases）. All of the cases with medial comminuted fracture of proximal humerus were treated by replacement, and complicated with the bone defects at the affected part during replacement. The 46 cases were divided into the bone graft group（n=20） and the non-graft group（n=26）. The reconstruction of the medial column support of proximal humeral fracture was performed for the cases in the two groups by medial support screws. The fracture healing time, Constant-Murley scores of shoulder joint, visual analgesia scores（VAS）, varus angle of humerus and the incidence rate of complications were compared between two groups at the time of the latest follow-up. Results The follow-up was carried out for 14～41 months（19.8±2.48） after operation. The Constant-Murley scores of shoulder joint, VAS, varus angle of humerus and the incidence rate of complications were （76.0±7.9）points, （2.7±0.8）points, （0.7±1.2）° and 15.00% in the bone graft group, and those were （75.5±6.5）points, （3.1±1.1）points, （1.2±1.0）° and 19.23% in the non-graft group（P〉0.05）. The fracture healing time of the bone graft group（14.6±2.4 weeks） was significantly shorter than that of the non-graft group（16.2±2.9 weeks）（P〈0.05）. Conclusion In the treatment of proximal humeral fracture without bone graft, locking plate combined with the reconstruction of the medial column support by medial support screws can get better fixation and clinical effects for the medial comminuted fracture of proximal humerus complicated with bone defects or severe defects of medial cortical bone.