Maddah Mohammad, Prall Wolf C, Geyer Lucas, Wirth Stefan, Mutschler Wolf, Ockert Ben
Department of Trauma and Orthopedic Surgery, Ludwig-Maximilians-University , Munich, Germany.
Department of Clinical Radiology, Ludwig-Maximilians-University , Munich, Germany.
Orthop Rev (Pavia). 2014 Jun 24;6(2):5336. doi: 10.4081/or.2014.5336. eCollection 2014 Apr 22.
The aim of the study was to examine the correlation between the chosen position of screws and the complications observed in patients who underwent locked plating of proximal humeral fractures. We evaluated radiographs of 367 patients treated by locked-plating for proximal humeral fractures. Radiographs were taken at one day, 6 weeks, 3 months and 6 months after surgery, and were analyzed for secondary fracture displacement, loss of fixation, cutting out of screws and necrosis of the humeral head. Secondary loss of fixation occurred in 58 cases (15.8%) and among those cutting out of screws was observed in 25 cases (6.8%). In cases of secondary loss of fixation a mean of 6.7 screws were used to fix the fracture (vs 6.6, P=0.425). There was neither significant correlation between position of screws and the occurrence of postoperative loss of fixation in Spearman correlation nor relationship from backward logistic regression analysis. Loss of fixation following locked plating of proximal humeral fractures does not relate to the number of screws and their positions in the humeral head. In consequence, anatomic fracture reduction and restoration of the humeral head-shaft angle are still important factors and should not be disregarded.
本研究的目的是探讨在接受肱骨近端骨折锁定钢板固定的患者中，所选螺钉位置与观察到的并发症之间的相关性。我们评估了367例接受肱骨近端骨折锁定钢板治疗患者的X线片。术后1天、6周、3个月和6个月拍摄X线片，并分析继发性骨折移位、内固定失效、螺钉穿出和肱骨头坏死情况。58例（15.8%）出现继发性内固定失效，其中25例（6.8%）观察到螺钉穿出。在继发性内固定失效的病例中，平均使用6.7枚螺钉固定骨折（对比6.6枚，P = 0.425）。在Spearman相关性分析中，螺钉位置与术后内固定失效的发生之间既无显著相关性，在向后逻辑回归分析中也无关联。肱骨近端骨折锁定钢板固定后的内固定失效与螺钉数量及其在肱骨头中的位置无关。因此，解剖复位骨折和恢复肱骨头-骨干角度仍然是重要因素，不应被忽视。
