反置肩关节置换治疗肱骨近端骨折中影响术后肱骨大结节愈合的因素分析

Influence factors of healing time of humerus greater tuberosity after reverse shoulder arthroplasty in proximal humerus fracture

目的分析探讨肱骨近端骨折反置肩关节置换术治疗中可能影响术后肱骨大结节愈合时间的影响因素。方法回顾分析2018年8月至2019年8月上海交通大学医学院附属瑞金医院骨科收治的14例患者;其中男4例,女10例,年龄67~95(80.0±8.1)岁;左侧8例,右侧6例。所有患者均因肱骨近端骨折行反置肩关节置换术。通过术前及术后影像学测量分析可能的影响因素。结果肱骨近端骨折反置肩关节置换治疗中,影响肱骨大结节骨折愈合时间的主要因素为大结节与近端皮质是否接触(P<0.01)、肱骨大结节骨块是否粉碎(P=0.01;P=0.04)以及肱骨大结节骨块前后向长度(P=0.02)。相比之下,肱骨近端骨折骨折是否合并不可修复肩袖损伤对反置肩关节置换术后肱骨大结节愈合时间无明显影响。结论采用反置肩关节置换治疗肱骨近端骨折,肱骨大结节与近端皮质不连续会导致肱骨大结节术后延迟愈合。粉碎的肱骨大结节尤其是前后向骨块较小的肱骨大结节可延长术后大结节愈合所需时间。

Objective To analyze the factors that influence the healing time of humerus greater tuberosity after reverse shoulder arthroplasty in proximal humerus fracture. Methods Fourteen patients(10 women and 4 men) with proximal humerus fractures underwent reverse shoulder arthroplasty in Department of Orthopedic, Shanghai Jiaotong University School of Medicine affiliated Ruijin Hospital from August 2018 to August 2019. The ages of the patients at trauma was 75.8-84.2(80.0±7.8) years. The influences concluded the differences between the pre-and post-operative radiology images. Results In the reverse shoulder arthroplasty treatment for proximal humerus fracture, the direct contact of humerus greater tuberosity and proximal humerus cortical bone(P<0.01), the comminuted humerus greater tuberosity(P=0.01;P=0.04) and the forward and backward length of humerus greater tuberosity fracture block(P=0.02) would influence the healing time of humerus greater tuberosity. While irreparable rotator cuff lesion makes no significant difference. Conclusions To treat proximal humerus fracture with reverse shoulder arthroplasty, the discontinuity of humerus greater tuberosity and proximal cortical bone would delay the healing time of humerus greater tuberosity. The comminuted humerus greater tuberosity and reduced length of forward and backward length of humerus greater tuberosity would also delay the healing time of humerus greater tuberosity.