解剖锁定钢板内固定治疗不同Neer分型肱骨近端骨折的疗效对比

Efficacy of anatomical locking plate internal fixation in the treatment of proximal humeral fractures with different Neer classifications

目的 探讨解剖锁定钢板内固定治疗不同Neer分型肱骨近端骨折的临床疗效。方法 选取2017年1月至2019年1月在陕西省人民医院接受解剖锁定钢板内固定治疗的NeerⅡ~Ⅳ型肱骨近端骨折患者120例,其中NeerⅡ型32例(NeerⅡ型组),NeerⅢ型46例(NeerⅢ型组),NeerⅣ型42例(NeerⅣ型组)。记录三组患者的围术期指标,术后3个月、6个月及末次随访时的疼痛视觉模拟量表(visual analogue scale,VAS)评分、Constant-Murley肩关节功能评分和美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)肩关节功能评分,术前和末次随访时的肩关节前屈上举、外旋、外展角度,以及各组的并发症发生情况。结果NeerⅣ型组患者的手术时间、术中出血量、住院时间、骨折愈合时间均高于NeerⅢ型组和NeerⅡ型组,且NeerⅢ型组高于NeerⅡ型组,差异均有显著性(P<0.05);NeerⅡ型组的术后负重时间短于NeerⅢ型组和NeerⅣ型组,差异有显著性(P<0.05),而NeerⅢ型组和NeerⅣ型组比较差异无显著性(P>0.05)。所有患者术后随访12~20个月,平均(15.28±3.62)个月。术后3个月、6个月及末次随访时,NeerⅡ型组VAS评分明显低于NeerⅢ型组和NeerⅣ型组,且NeerⅢ型组明显低于NeerⅣ型组,而Constant-Murley评分和ASES评分NeerⅡ型组明显高于NeerⅢ型组和NeerⅣ型组,且NeerⅢ型组明显高于NeerⅣ型组,差异均有显著性(P<0.05)。与术前相比,末次随访时三组患者肩关节前屈上举、外旋和外展角度均明显增加,且NeerⅡ型组明显大于NeerⅢ型组和NeerⅣ型组,NeerⅢ型组明显大于NeerⅣ型组,差异均有显著性(P<0.05)。各组术后并发症发生率比较差异无显著性(P>0.05)。Spearman相关分析显示,Neer分型与手术时间、术中出血量、住院时间、骨折愈合时间和负重时间呈正相关,与术后Constant-Murley评分和ASES评分呈负相关(P<0.001)。结论 解剖锁定钢板内固定治疗肱骨近端骨折疗效较好,安全性较高,但不同Neer分型患者的围术期指标及肩关节功能恢复情况不同,因此术后应进行科学合理的康复训练,以提高肩关节功能优良率。

Objective To observe the efficacy of anatomical locking plate internal fixation in the treatment of proximal humeral fractures with different Neer classifications.Method Totally 120 patients of NeerⅡ-Ⅳproximal humeral fractures received anatomical locking plate internal fixation treatment from January 2017 to January 2019 in our hospital were selected,including NeerⅡ32 cases,NeerⅢ46cases,NeerⅣ42 cases.The perioperative indicators,visual analogue scale(VAS),Constant-Murley shoulder function score and American Shoulder and Elbow Surgeons(ASES)shoulder function score at 3 months,6 months and the last follow-up were recorded.The shoulder flexion,lifting,external rotation and abduction angle were recorded before operation and during the last follow-up.The complications of each group were compared.Result The operation time,intraoperative bleeding,hospital stay and fracture healing time in Neer type IV group were higher than both Neer type III group and Neer type II group,and the difference was significant(P<0.05).The postoperative weight-bearing time of NeerⅡgroup was shorter than both NeerⅢandⅣgroups(P<0.05),but there was no significant difference between NeerⅢandⅣgroups(P>0.05).All patients were followed up for 12 to 20 months,with an average of(15.28±3.62)months.At 3 months,6 months and the last follow-up,the VAS score of NeerⅡgroup was significantly lower than NeerⅢandⅣgroups,and that of NeerⅢwas significantly lower than NeerⅣ,while the Constant-Murley score and ASES score of NeerⅡgroup were significantly higher than NeerⅢgroup and NeerⅣgroup,and those of NeerⅢgroup was significantly higher than NeerⅣgroup(P<0.05).The shoulder flexion,lifting,external rotation and abduction angles of the three groups were significantly increased at the last follow-up,and those of the NeerⅡgroup were significantly greater than NeerⅢandⅣgroup,while the NeerⅢgroup was significantly greater than NeerⅣgroup(P<0.05).There was no significant difference in the incidence of postoperative complications among the groups(P>0.05).Spearman correlation analysis showed that Neer classification was positively correlated with operation time,intraoperative bleeding,hospital stay,fracture healing time and weight-bearing time,and negatively correlated with postoperative Constant-Murley score and ASES score(P<0.001).Conclusion Patients of proximal humeral fracture received anatomical locking plate internal fixation had a good efficacy and safety,however,patients with different Neer types had different perioperative indicators,clinical efficacy and shoulder function recovery,therefore,according to the basis of injury,scientific and reasonable postoperative treatment and rehabilitation training should be carried out to improve the good rate of shoulder joint.