不稳定肱骨近端骨折内固定术后早期肱骨头内翻的影响因素

Influencing factors of early humeral head varus after internal fixation for unstable proximal humeral fractures

目的探讨不稳定肱骨近端骨折内固定术后早期肱骨头内翻的影响因素。方法抽取焦作市第二人民医院2017年3月至2021年3月收治的不稳定肱骨近端骨折患者143例,均行内固定术治疗。依据患者术后是否发生早期肱骨头内翻分为内翻组与无内翻组。采用单因素和多因素Logistic回归分析法分析术后早期肱骨头内翻的影响因素,调查因素包括性别、年龄、Neer分型、体质指数、致伤原因、合并基础疾病、文化程度、内固定物选择、置入螺钉、内侧骨皮质缺损及术中肱骨颈干角。结果143例不稳定肱骨近端骨折患者中,术后早期出现肱骨头内翻19例,未发生肱骨头内翻124例。单因素分析结果显示,内翻组与无内翻组性别、年龄、Neer分型、体质指数、致伤原因和文化程度比较差异未见统计学意义(P>0.05);内翻组与无内翻组内固定物选择、置入螺钉、内侧骨皮质缺损和术中肱骨颈干角比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,内固定物选择、置入螺钉、内侧骨皮质缺损和术中肱骨颈干角为影响术后早期肱骨头内翻的危险因素。结论不稳定肱骨近端骨折内固定术后早期肱骨头内翻发生率较高,内固定物选择、置入螺钉、内侧骨皮质缺损和术中肱骨颈干角为其危险因素。

Objective To investigate the influencing factors of early humeral head varus after internal fixation for unstable proximal humeral fractures.Methods A total of 143 patients of unstable proximal humeral fractures treated in the Second People’s Hospital of Jiaozuo from March 2017 to March 2021 were selected.All of them were treated by internal fixation.The patients were divided into varus group and non varus group according to occurrence of early varus of humeral head after operation.Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of early postoperative humeral head varus.The investigation factors included gender,age,Neer classification,body mass index,cause of injury,combined with basic diseases,education level,choice of internal fixation,screw placement,medial cortical defect and humeral neck shaft angle.Results Among 43 patients with unstable proximal humeral fractures,19 cases had humeral head varus early after operation,and 124 cases had no humeral head varus.Univariate analysis showed that there was no significant difference in gender,age,Neer classification,body mass index,injury cause and education level between the two groups(P>0.05);there were significant differences in the choice of internal fixation,screw placement,medial cortical defect and humeral neck shaft angle between the varus group and the non varus group(P<0.05).Multivariate Logistic regression analysis showed that the choice of internal fixation,screw placement,medial cortical defect and humeral neck shaft angle were the risk factors for early postoperative humeral head varus.Conclusions The incidence of early humeral head varus after internal fixation of unstable proximal humeral fractures is high,and the selection of internal fixation,screw placement,medial cortical defect and humeral neck shaft angle are the risk factors.