锁定钢板治疗肱骨近端骨折中颈干角变化与临床疗效相关性研究

Treatment of Proximal Humeral Fractures Using Locking Plate:Correlation of Clinical Efficacy and the Variation in the Neck-shaft Angle

目的研究肱骨颈干角变化对锁定钢板治疗肱骨近端骨折术后疗效的影响。方法 2013年1月~2016年5月采用锁定钢板治疗的肱骨近端骨折患者51例,记录肩关节活动、Constant评分及术后并发症发生,摄X片比较患侧和健侧颈干角,将患者分为正常组、外翻组、内翻组。比较三组间活动、功能评分的差别。结果 51例患者肩关节前屈上举118.6±24.3°,外旋39.2±17.4°,外展83.3±22.4°,Constant评分79.7±6.7分,优良率达76.5%。三组间患者术后活动、功能评分有统计学差异,正常组活动及功能评分优于内翻组、外翻组,内翻组的前屈上举、外展、功能评分均差于外翻组。结论肱骨近端骨折术后颈干角恢复是肩关节功能的影响因素之一,尤其应避免内翻出现,术中应尽量解剖复位、内固定可以降低该并发症发生。

Objective This study aimed to investigate the correlation with the clinical efficacy and the neck-shaft angle of proximal humerus fractures treated using anlocking plate for the proximalhumerus.Methods A total of 51 patients with fractures of the proximal humerus who had been treated using alocking plate were involved from January 2013 to May 2016.These patients were assessed using range of motion of the shoulder,the Constant score and complication.We divided patients into three groups（normal group,valgus group and varus group）to compare the postoperative range of motion and the Constant score.Results There was significant difference with the range of motion and the Constant score among groups.The range of motion and the Constant score of normal group were superior to that of valgus group and varus group.The flexion,abduction and the Constant score of varus group were inferior to that of valgus group.Conclusion The recovery of the neck-shaft angle after proximal humerus fractures treated using a locking plate is one of the factors affecting the function of the shoulder joint,especially avoiding the appearance of varus,the intraoperative anatomical reduction and internal fixation should be used as far as possible to reduce the incidence of complications.