肱骨近端骨折钢板治疗的并发症及处理

Complications of plate fixation for proximal humeral fractures and their management

[目的]探讨肱骨近端骨折采用切开复位解剖钢板内固定的并发症特点及处理结果。[方法]回顾性分析2018年1月—2021年1月共114例采用切开复位解剖钢板内固定的肱骨近端骨折患者的临床资料。探讨其并发症的分布与特点、处理和结局。[结果]114例患者共发生并发症32例(28.1%),并发症发生率由高至低依次是骨折复位不良8/114(7.0%)、内固定位置不良7/114(6.1%)、内固定松动5/114(4.4%)、畸形愈合4/114(3.5%)、肩峰下撞击4/114(3.5%)、股骨头坏死2/114(1.8%)、切口愈合不良1/114(0.9%)、感染1/114例(0.9%)。各类并发症的发生率差异有统计学意义(P<0.05)。按骨折类型,总并发症率:二部分骨折为4/16(25.0%),三部分骨折为17/82(20.7%),四部分骨折为7/8(87.5%),骨折脱位为4/8(50.0%),差异有统计学意义(P<0.05)。经相应处理,所有患者均无严重不良结果。末次随访时,32例患者中,12例完全无痛,15例活动时轻度疼痛,5例明显疼痛;10例肩关节活动不受限,18例轻度受限,4例明显受限;14例恢复伤前运动和劳动能力,18例未恢复至伤前运动劳动能力水平。[结论]肱骨近端骨折采用切开复位钢板内固定的晚期并发症发生率达13.2%,最常见并发症是内固定松动、畸形愈合和肩峰下撞击,应引起重视。

[Objective] To investigate the characteristics and management results of complications of open reduction and plate internal fixation for proximal humeral fractures. [Methods] From January 2018 to January 2021, a total of 114 patients received open reduction and plate internal fixation for proximal humeral fractures in our hospital. The occurrence, characteristics, management and outcome of complications were assayed in this arthicle. [Results] Among 114 patients, 32/114(28.1%) had late complications, including poor fracture reduction8/114(7.0%), poor internal fixation position 7/114(6.1%), loose internal fixation 5/114(4.4%), malunion 4/114(3.5%), subacromial impact 4/114(3.5%), femoral head necrosis 2/114(1.8%), incision malunion 1/114(0.9%), infection 1/114(0.9%), which proved statistically significant in term of the incidence of various complications(P<0.05). In term of fracture classification, the total complication rate was of 4/16(25.0%) in the two-part fracture, 17/82(20.7%) in the three-part fracture, 7/8(87.5%) in the four-part fracture and 4/8(50.0%) in the fracture dislocation, with a significantly difference among them(P<0.05). After corresponding treatment, all patients had no serious adverse consequences. Of them, 12 patients had no pain at all, 15 patients had mild pain during activities, and 5 patients had obvious pain;10 patients had on shoulder motion affected, 18 cases got mildly limited, and 4 cases had significantly limited motion;14 cases regained sports and labor capacity to the levels before injury, while 18 cases were under the levels at the latest follow-up. [Conclusion] The complications of open reduction plate internal fixation of proximal humerus fractures are as high as 13.2%, and the most common complications are loosening of internal fixation, malunion and subacromial impingement, which should be paid more attention to.