内侧柱不同支撑螺钉数量对锁定钢板治疗肱骨近端骨折疗效的影响

Effect of Various Medial Column Supporting Screws on in the Treatment of Proximal Humeral Fracture with Locking Plate

[目的]探讨内侧柱不同支撑螺钉数量对锁定钢板治疗肱骨近端骨折疗效的影响。[方法]回顾性分析2017年8月至2018年9月在本院骨科收治的76例肱骨近端骨折患者临床资料,根据内侧柱支撑螺钉数量的不同分为无支撑螺钉组(A组,n=25).1枚支撑螺钉组(B组,n=19).2枚支撑螺钉组(C组,n=17),3枚支撑螺钉组(D组,n=15)。随访12个月,比较四组患者抗剪切力刚度、抗压刚度、骨折愈合时间、肱骨头高度丢失值、颈干角、内翻角.Constant肩关节评分及术后并发症发生率。[结果]D组患者的抗剪切力刚度及抗压刚度最大,均优于A组、B组及C组,且组间比较均具有统计学意义(均P<0.05)。四组患者骨折愈合时间、颈干角比较差异均无统计学意义(均P>0.05);A组、B组、C组、D组肱骨头丢失值、内翻角依次减少,且组间比较差异有统计学意义(P>0.05);A组、B组.C|组.D组术后1个月、2个月、3个月、6个月、12个月肩关节功能Constant评分逐渐增加,D组Constant评分最高,组间比较差异均有统计学意义(P<0.05)。A组、B组、C组、D组并发症总发生率分别为40%(10/25).42.10%(8/19).17.64%(3/17).13.34%(2/15),组间比较差异无统计学意义(F=5.705,P=0.127)。[结论]选择2枚或3枚螺钉内侧柱支撑对锁定钢板治疗肱骨近端骨折可达到满意的恢复效果。其中使用3枚支撑螺钉临床疗效最佳。

[Objective]To investigate the efet of dfferent numbers of medial column supporting screws on proximal humeral fracture with locking plate.[Methods]A retrospective analysis of the clinical data of 76 patients with proximal humeral fractures treated in the Orthopedics Department of our hospital from August 2017 to September 2018.They were divided into 4 groups based on the number of medial column support screws used in the surgery:There were 25 patients in the nonr supporting screw group,19 patients in the 1 supporting screw group,17 patients in the 2 supporting screws group,and 15 patients in the 3 supporting screws group.During the followup of 12 months,the shear stiffness,com-pressive stiffness,fracture healing time,humeral head height loss value,neck shaft angle,varus angle,constant shoulder score and postoperative complications were compared between the four groups.[ResultsJThe patients with three support-ing screws had the highest shear stiffness and compressive stiffness,which were better than those without supporting screws,one supporting screw group and two supporting screw group(P<0.05).The fracture healing time without sup-porting screw,1 supporting screw group,2 supporting screws group,and 3 supporting screws group were(14.25±2.30),(14.33±2.45),(15.18±3.51)and(15.68±4.63),respectively.There were no statistically significant differ-ences in fracture healing time and neck-shaft angle between the four groups(all P>0.05).The values of humeral head loss and varus angle in group A,group B,group C,and group D decreased sequentially,and the difference between the groups was staistically significant(P<0.05).The Constant scores of shoulder joint function increased gradually in groups A,B,C,and Dat 1 month,2 months,3 months,6 months,and 12 months after surgery.The Constant score of group D was the highest,and there were dfferences between the groups(P<0.05).The incidence of postoperative complications in the 3 supporting screws group,2 supporting screws group,1 supporting screw group,and no supporting screw group were 40%(10/25).42.10%(8/19).17.64%(3/17)and 13.34%(2/15),respectively.The differences of groups were not statistically significant(P>0.05).[Conclusion]Choosing 2 or 3 screws t0 support the medial column can achieve a satisfactory recovery results the treatment of proximal humeral fractures with locking plate.The use of 3 supprting screws has the best clinical effect.