肱骨近端骨折经微创钢板接骨术治疗术后的放射学测量与肩关节功能关系

Relationship between radiological measurements and shoulder joint function after minimally invasive plate osteosynthesis of proximal humeral fractures

目的探讨肱骨近端骨折经微创钢板接骨术治疗术后的放射学参数与肩关节功能的关系。方法选取2016年1月1日至2022年6月30日期间在本院由同一位高级职称医师主刀的微创钢板接骨术治疗的51例肱骨近端骨折患者,对这些患者术后3 d内的X线片放射学参数进行分析,包括肱骨头直径、肱骨头高度、垂直中心、颈干角、肱骨头直径与肱骨轴线交角、垂直高度、头结节距离和头钢板距离,并于术后12个月后随访评估Constant评分和快速上肢功能评定表(disabilities of the arm,shoulder and hand,DASH)评分。研究对象分为两组:以Constant评分结果分为优秀和良好以及一般和较差的患者;以快速DASH评分结果分为较好和较差的患者。对两组的基线资料和放射学参数进行了差异比较。使用回归分析评价放射学参数和肩关节功能评分的依存性。结果患者Constant评分为(82.55±11.25)分。按Constant评分的结果分类,51例患者中45例患者的评分结果为优秀或良好,6例患者的评分结果为一般或较差。长期随访结果一般或较差的患者通常术后测得的肱骨颈干角、肱骨头直径与轴线交角更大,垂直高度更低。患者快速DASH评分为(12.06±8.55)分。按快速DASH评分的结果分类,51例患者中有43例患者的评分结果为较好,8例患者的评分结果为较差。长期随访结果较差的患者通常受伤到手术间隔时间较长,术后测得的肱骨颈干角、肱骨头直径与轴线交角更大,肱骨头高度和垂直高度更低。通过回归分析得到部分放射学参数的合理范围(肱骨颈干角:117.94~138.21°,肱骨头直径与轴线交角:28.72~46.72°,垂直高度:≥36.61 mm)。结论肱骨近端骨折经微创钢板接骨术治疗后,肱骨颈干角以及肱骨头直径与轴线交角较大,垂直高度较小的患者肩关节功能较差。通过回归分析进一步确定了肱骨颈干角、肱骨头直径与轴线交角的合适范围以及垂直高度的必要大小,骨科医生可以当作术中参考。

Background Proximal humerus fractures are common,accounting for about 40%of adult humerus fractures.Currently,the treatment of proximal humeral fractures is divided into conservative treatment and surgical treatment,which includes intramedullary nail fixation,open reduction and internal fixation(ORIF),minimally invasive plate osteosynthesis(MIPO),and reverse shoulder arthroplasty(RSA).Previous studies have shown that ORIF has a high incidence of complications,including varus malunion,osteonecrosis,screw perforation or cut-out,subacromial impingement syndrome,infection,etc.Compared with ORIF,MIPO has the advantages of less blood loss,shorter operation time,less postoperative pain,shorter fracture healing time,and improved muscle strength recovery.Previous studies have found that some imaging parameters may influence the outcome of ORIF.According to our literature search,no scholars have conducted detailed measurements of radiological parameters after MIPO.Therefore,in this study,we correlated baseline data and postoperative radiological parameters of patients undergoing MIPO with shoulder joint function to determine which factors influence surgical outcomes.Objective To investigate the relationship between radiological parameters and shoulder joint function after MIPO of proximal humeral fracture.Methods Fifty-one patients with proximal humeral fractures who received MIPO with the same senior physician in our hospital from January 1,2016,to June 30,2022,were selected,and radiological parameters of the X-ray radiographs of these patients were analyzed within three days after surgery.Humerus head diameter,humerus head height,vertical center,neck-shaft angle,angle of humeral head diameter and humeral axis,vertical height,head-tuberosity distance,and head-plate distance were included.Constant-Murley and rapid DASH scores were assessed at the 12th-month follow-up after surgery.The subjects were divided into two groups.They were divided into the excellent and good group and the average and poor group according to the Constant-Murley score,and divided into the good group and the poor group according to the rapid DASH score.Baseline data and radiological parameters were compared between the two groups.Regression analysis was used to evaluate the dependence of radiological parameters on shoulder joint function scores.Results The patients'Constant-Murley score was(82.55±11.25)points.According to the results of the Constant-Murley score,45 of the 51 patients had excellent or good results,and six patients had moderate or poor results.Patients with moderate or poor long-term follow-up results usually had larger humeral-shaft angle,humeral head diameter,and angle of humeral head diameter and humeral axis and smaller vertical height.The patients'DASH score was(12.06±8.55)points.According to the rapid DASH score results,43 of 51 patients had good results,and eight patients had poor results.Patients with poor long-term follow-up results usually had longer injury to surgery interval,larger humeral neck-shaft angle and angle of humeral head diameter and humeral axis,and smaller humeral head height and vertical height.The reasonable range of some radiological parameters was obtained by regression analysis(humeral neck-shaft angle:117.94-138.21°,angle of humeral head diameter and humeral axis:28.72-46.72°and vertical height:≥36.61 mm).Conclusion After MIPO of proximal humeral fractures,patients with larger humeral neck-shaft angle,larger angle of humeral head diameter and humeral axis,and smaller vertical height had poorer shoulder joint function.By regression analysis,we further determined the proper range of humeral neck-shaft angle,humeral head diameter,and angle of humeral head diameter and humeral axis,and the necessary vertical height,which can be used as references by orthopedic surgeons.