肱骨近端双结节锁定钢板治疗肱骨近端骨折

Treatment of proximal humeral fractures with dual-tuberosity locking plate

目的探讨肱骨近端双结节锁定钢板治疗肱骨近端骨折的疗效。方法回顾性分析2017年7月至2019年7月采用肱骨近端双结节锁定钢板治疗19例肱骨近端骨折患者资料,男7例,女12例;年龄(64.0±12.8)岁(范围,32~85岁);依据肱骨近端骨折Neer分型,其中两部分肱骨近端骨折1例,三部分肱骨近端骨折9例,四部分肱骨近端骨折9例;9例大、小结节均骨折,10例仅大结节骨折。记录所有患者末次随访时的Constant-Murley肩关节评分、上肢功能障碍(disability of the arm,shoulder and hand,DASH)评分量表、视觉模拟评分(visual analogue scale,VAS)、颈干角改变量、肱骨头高度改变量、患肢活动范围、骨折愈合情况以及其他并发症情况。结果术后19例患者均获得随访,随访时间16.1个月(范围,12~18个月)。末次随访时19例患者骨折均已愈合,Constant-Murley肩关节评分为(84.2±11.0)分(范围,55~98分);DASH评分为(19.4±11.6)分(范围,2.3~47.8分);VAS评分为(1.6±1.3)分(范围,0~4分),其中轻微疼痛17例(89.5%,17/19)。19例患者术后第1天颈干角141.9°±9.8°(范围,132.17°~162.66°,肱骨头高度(18.0±5.9)mm(范围,7.45~27.12 mm);末次随访时颈干角148.6°±7.5°(范围,132.70°~159.39°),肱骨头高度(17.4±5.5)mm(范围,5.02~27.31 mm);颈干角改变量为3.29°(范围,0.68°~33.10°),肱骨头高度改变量0.68 mm(范围,1.32~6.56 mm),其中内固定失效4例。术后第1天,1例出现距螺钉穿出,该例患者术后第17天出现伤口感染,予以清创术治疗后感染控制。无一例出现大、小结节吸收或畸形愈合。结论肱骨近端双结节锁定钢板能够同时固定大、小结节骨折块,维持结节骨折块与肱骨干之间的相对位置,减少术后结节再移位或畸形愈合,术后疗效满意。

Objective To evaluate the efficacy of dual-tuberosity locking plate for the treatment of proximal humeral fractures.Methods This study retrospectively analyzed data of patients with proximal humeral fractures treated with a new locking plate from July 2017 to July 2019.Finally,19 eligible patients were included,including 12 females and 7 males,with an average age of 64.0±12.8 years(range,32-85 years).According to the Neer classification of proximal humeral fractures,1 case was two-part fractures,9 cases three-part fractures and 9 cases four-part fractures.Among them,9 cases combined with greater and lesser tuberosities fractures and 10 cases with isolated greater tuberosity fractures.Constant-Murley and disabilities of the arm shoulder and hand(DASH)scores,the change of neck-shaft angle,the change of humeral head height,tuberosity consolidation and other complications were recorded at the latest follow-up.Results The mean follow-up time was 16.1 months(range,12-18 months).All fractures were healed within follow-up period.Mean Constant-Murley score was 84.2±11.0(range,55-98),DASH score was 19.4±11.6(range,2.3-47.8)and VAS was 1.6±1.3(range,0-4)at the latest follow-up.As for the radiographic results,19 patients had a mean neck-stem angle of 141.9°±9.8°(range,132.17°-162.66°)on the first day after surgery,and a mean humeral head height of 18.0±5.9 mm(range,7.45-27.12 mm).The mean neck-stem angle was 148.6°±7.5°(range,132.70°-159.39°)and the mean humeral head height was 17.4±5.5 mm(range,5.02-27.31 mm)at the latest follow-up.The average change of neck-stem angle was 3.29°(range,0.68°-33.10°),and mean change of humeral head height was 0.68 mm(range,1.32-6.56 mm).No fractures developed greater or lesser tuberosity absorption or malunion,but 4 cases suffered loss of fixation and 1 developed primary intra-articular screw penetration as well as wound infection.Conclusion In the open reduction and internal fixation of the proximal humeral fractures,the new locking plate can fix greater and lesser tuberosity fractures simultaneously,which helps reduce their displacement and deformity of tuberosities.By given that,satisfactory radiographic outcomes and shoulder functions can be obtained.