肱骨头下皮质外距螺钉重建内侧柱治疗老年肱骨近端骨折的临床疗效

Application of exo-cortical calcar screw for reconstruction of medial column stability for treatment of proximal humeral factures in older patients

目的分析应用肱骨头下皮质外距螺钉重建老年肱骨近端骨折内侧柱的临床疗效。方法自2017年1月至2019年12月我院采用锁定钢板治疗肱骨近端骨折患者34例。根据Neer分型:三部分骨折19例,四部分骨折15例。术后根据肱骨头距螺钉分布位置分为二组:A组为肱骨头内距螺钉组(18例):将2枚距螺钉位于肱骨头内下象限,距螺钉与骨小梁接触,提供支撑;B组为肱骨头外距螺钉组(16例):1或2枚距螺钉位于肱骨头下皮质外,距螺钉尖与皮质接触,提供内侧支撑。所有患者门诊随访时间为12~29个月,平均16.4个月。比较两组肱骨头内翻角、肩关节Constant评分及并发症发生率,分析肱骨头下皮质外距螺钉重建内侧柱对骨折复位的维持和肩关节功能的影响。结果A组和B组的肱骨头直径分别为(45.33±2.11)mm和(40.87±1.48)mm,两组之间差异有统计学意义(P<0.001)。两组患者骨折愈合时间为8~14周,平均10.9周,末次随访时两组患者肱骨头内翻角分别为1.73°(1.46°~2.01°)和1.93°(1.13°~2.42°),差异无统计学意义(P>0.05);而肩关节Constant功能评分分别为(80.67±6.18)分和(79.25±5.47)分,差异无统计学意义(P>0.05)。并发症发生率22.2%(4/18)和12.5%(2/16),差异无统计学意义(P>0.05)。结论当肱骨头直径较小时,将距螺钉置于肱骨头下皮质外,可重建内侧柱,维持骨折复位质量。

Objective To explore the clinical efficacy of exo-cortical calcar screw for reconstruction of medial column stability for treatment of proximal humeral fractures in older patients.Methods A total of 34 patients with proximal humeral fracture treated with PHILOS locking plates from January 2017 to December 2019 were retrospectively analyzed.According to Neer′s classification,there were 19 cases of three-part fractures,15 cases of four-part fractures.According to the distribution of calcar screws,they were divided into 2 groups:group A(18 cases),in which 2 calcar screw was inserted into the lower quadrant of the humeral head,providing medial support with bone trabecula;group B(16 cases),in which,1 or 2 calcar screws was inserted outside the cortex below the humeral head,providing medial support with cortical bone.All patients were followed up from 12 to 29 months in the outpatient department,with an average of 16.4 months.The varus angle of the humeral head,the shoulder Constant score and incidence of complications between two groups were compared,and the effects of reconstruction of medial column support with exo-cortical calcar screw on the maintenance of fracture reduction and shoulder joint function were analyzed.Results The diameter of the humeral head of group A and group B was(45.33±2.11)mm and(40.87±1.48)mm respectively,and there was significant difference between the two groups(P<0.001).The healing time of fractures was 8 to 14 weeks,with an average of 10.9 weeks.The average valgus angle of the humeral head between the group A and the group B was 1.73°(1.46°to 2.01°)and 1.93°(1.13°to 2.42°)respectively,with no statistically significant difference(P>0.05).The average Constant score of shoulder between the group A and the group B was(80.67±6.18)and(79.25±5.47)at the last follow-up respectively,with no statistically significant difference(P>0.05).The incidence of complications was 22.2%(4/18)and 12.5%(2/16),with no statistically significant difference(P>0.05).Conclusion When the diameter of the humeral head is small,exo-cortical calcar screw could be useful alternative for reconstructing medial column stability in proximal humeral fracture,maintaining the fracture reduction quality.