125例肱骨近端骨折病人内固定术后螺钉穿出肱骨头的危险因素分析

Analysis of the risk factors of screw perforating humerus head after internal fixation in 125 patients with proximal humerus fractures

目的:探讨肱骨近端骨折病人内固定术后螺钉穿出肱骨头的发生情况及其影响因素。方法:选择125例行切开复位锁定钢板内固定治疗的病人为研究对象,根据病人术后螺钉穿出肱骨头的发生情况分为2组,其中发生螺钉穿出的病人18例,无螺钉穿出的病人107例。分析肱骨近端骨折内固定术后发生螺钉穿出的影响因素。结果:125例肱骨近端骨折病人内固定术后螺钉穿出的发生率为14.4%(18/125)。单因素分析显示,存在内侧柱粉碎、Neer分型较高、内侧柱支撑、螺钉数目较少及复位程度较差的肱骨近端骨折病人内固定术后发生螺钉穿出的概率较高(P<0.05~P<0.01)。多因素logistic回归分析显示,Neer分型、内侧柱粉碎及复位程度较差是肱骨近端骨折病人内固定术后发生螺钉穿出的独立影响因素(P<0.01)。结论:Neer分型较高、内侧柱粉碎及复位程度差的肱骨近端骨折病人术后发生螺钉穿出的风险较高。临床上应采取一定的措施加强骨折稳定性及增加肱骨头支撑,从而降低螺钉穿出的发生风险,提高病人治疗效果。

Objective:To analyze the incidence and risk factors of screw perforating humeru after internal fixation in patients with proximal humerus fractures.Methods:The clinical data of 125 patients treated with open reduction-internal fixation with locking plates were analyzed.The patients were divided into two groups according to whether screw perforation.Among 125 cases,18 patients with screw perforation and 107 patients without screw perforation were found.The risk factors of screw perforation in patients with proximal humerus fractures after internal fixation were analyzed.Results:The incidence rate of screw perforation in patients with proximal humeral fractures after internal fixation was 14.4%(18/125).The results of univariate analysis showed that the probability of screw perforation in patients with proximal humerus fractures complicated with medial column crushing,higher Neer type,medial column support,fewer screws and poor reduction after internal fixation were higher(P<0.05 to P<0.01).The results of multivariate logistic regression analysis showed that the Neer type,medial column crushing and poor reduction were the independent influencing factors of screw perforation after internal fixation in patients with proximal humeral fractures(P<0.01).Conclusions:The probability of screw perforation in patients with proximal humerus fractures complicated with medial column crushing,high Neer type and poor reduction is high.Clinically,some measures should be taken to strengthen the fracture stability and increase the humeral head support,so as to reduce the risk of screw perforation and improve the treatment effect of patients.