术后初次颈干角对锁定钢板治疗肱骨近端骨折疗效的影响

Effect of primary neck shaft angle after operation on the treatment of proximal humerus fracture by locking plate

目的 :探讨术后初次颈干角对锁定钢板治疗肱骨近端骨折的疗效。方法 :自2014年6月至2016年9月采用锁定钢板治疗62例肱骨近端骨折患者,男29例,女33例;年龄34~74(55.95±9.48)岁。根据术后初次颈干角不同,将患者分为内翻组(颈干角<127°,n=15),正常组(颈干角127°~145°,n=36)和外翻组(颈干角>145°,n=11)。比较3组患者的手术时间、骨折愈合时间及并发症情况,并在末次随访时采用疼痛视觉模拟评分(VAS)和Neer肩关节功能评分进行疗效评价。结果:62例患者均获得随访,时间12~38个月,平均17.2个月。内翻组手术时间(2.37±0.59)h,正常组(2.60±0.49)h,外翻组(2.75±0.39)h;内翻组骨折愈合时间(3.99±0.48)个月,正常组(3.78±0.49)个月,外翻组(3.82±0.42)个月;内翻组VAS评分3.67±2.02,正常组3.22±2.06,外翻组4.09±1.58;3组患者在手术时间、骨折愈合时间和VAS评分方面比较,差异无统计学意义(P>0.05)。Neer肩关节功能评分,正常组(87.14±6.48)分和外翻组(84.31±9.05)分,均优于内翻组(75.93±9.77)分,差异有统计学意义(P<0.05)。内翻组4例出现并发症,正常组2例出现并发症,外翻组未出现明显并发症。结论:术后初次颈干角>127°对于锁定钢板治疗肱骨近端骨折可以减少并发症,提高患者术后肩关节功能,获得更满意的术后疗效。

Objective ：To explore the effect of postoperative initial neck stem angle on the treatment of proximal humeral fractures with locking plate. Methods ： From June 2014 to Septembetr 2016,62 patients with proximal humeral fraetures underwent internal fixation with locking plates were retrospectively analyzed, including 29 males and 33 females with an average age of （55.95±9.48 ） years old ranging from 34 to 74 years old. According to the difference of the initial neck stem angle, the patients were divided into three groups, 15 patients in the varus group had less than 127° postoperative initial neck-shaft angle, 36 patients in the normal group had 127° to 145° postoperative initial neck-shaft angle, 11 patients in the valgus group had more than 145° postoperative initial neck-shaft angle. The operating time, fracture healing time, complications, the visual analogue scale （VAS） and shoulder functional Neer scores among three groups were compared for analysis. Results ： All 62 patients were followed up for 17.2 months （ranged 12 to 38 months）. Operative time,fracture healing time and VAS were （2.37±0.59） hours, （3.99±0.48） months and （3.67±2.02） points in the varus group; （2.60±0.49） hours, （3.78±0.49） months and （3.22±2.06） points in the normal group; （2.75±0.39） hours, （3.82±0.42） months and （4.09±1.58） points in the valgus group. There was no statistical difference in operating time, fracture healing time and VAS among these groups （P〉0.05）. The Neer score （87.14±6.48） in the normal group and （84.31±9.05） in the valgus group was significantly better than （75.93±9.77） in the varus group （P〈0.05）. Among them, 4 cases occurred complications in the varus group;2 cases in the normal group;while no complication occurred in the valgus group. Conclusion ： The internal fixation with locking plates of the proximal humerus fractures with postoperative initial neckshaft angle more than 127° can reduce complications, improve shoulder function and allow for better postoperative outcome.