Wang Bing, Zhu Cheng, Wang Ping, Wu Zi-Zheng, Zhang Qian-Fa
Department of Hand Orthopaedics, Baoshan Branch of Shanghai First People's Hospital, Shanghai 200940, China;
Department of Hand Orthopaedics, Baoshan Branch of Shanghai First People's Hospital, Shanghai 200940, China.
Zhongguo Gu Shang. 2018 Sep 25;31(9):794-798. doi: 10.3969/j.issn.1003-0034.2018.09.003.
To explore the effect of postoperative initial neck stem angle on the treatment of proximal humeral fractures with locking plate.
From June 2014 to Septembetr 2016, 62 patients with proximal humeral fractures underwent internal fixation with locking plates were retrospectively analyzed, including 29 males and 33 females with an average age of(55.95±9.48) years old ranging from 34 to 74 years old. According to the difference of the initial neck stem angle, the patients were divided into three groups, 15 patients in the varus group had less than 127° postoperative initial neck-shaft angle, 36 patients in the normal group had 127° to 145° postoperative initial neck-shaft angle, 11 patients in the valgus group had more than 145° postoperative initial neck-shaft angle. The operating time, fracture healing time, complications, the visual analogue scale(VAS) and shoulder functional Neer scores among three groups were compared for analysis.
All 62 patients were followed up for 17.2 months(ranged 12 to 38 months). Operative time, fracture healing time and VAS were(2.37±0.59) hours, (3.99±0.48) months and(3.67±2.02) points in the varus group;(2.60±0.49) hours, (3.78±0.49) months and(3.22±2.06) points in the normal group;(2.75±0.39) hours, (3.82±0.42) months and (4.09±1.58) points in the valgus group. There was no statistical difference in operating time, fracture healing time and VAS among these groups(>0.05). The Neer score(87.14±6.48) in the normal group and(84.31±9.05) in the valgus group was significantly better than(75.93±9.77) in the varus group (<0.05). Among them, 4 cases occurred complications in the varus group;2 cases in the normal group;while no complication occurred in the valgus group.
The internal fixation with locking plates of the proximal humerus fractures with postoperative initial neck-shaft angle more than 127° can reduce complications, improve shoulder function and allow for better postoperative outcome.
探讨术后初始颈干角对肱骨近端骨折锁定钢板治疗效果的影响。
回顾性分析2014年6月至2016年9月期间62例行肱骨近端骨折切开复位锁定钢板内固定术的患者资料，其中男性29例，女性33例，年龄34～74岁，平均（55.95±9.48）岁。根据术后初始颈干角的不同将患者分为三组，内翻组15例，术后初始颈干角小于127°；正常组36例，术后初始颈干角为127°～145°；外翻组11例，术后初始颈干角大于145°。比较三组患者的手术时间、骨折愈合时间、并发症、视觉模拟评分（VAS）及肩关节功能Neer评分。
62例患者均获随访，时间12～38个月，平均17.2个月。内翻组手术时间、骨折愈合时间及VAS评分分别为（2.37±0.59）小时、（3.99±0.48）个月、（3.67±2.02）分；正常组分别为（2.60±0.49）小时、（3.78±0.49）个月、（3.22±2.06）分；外翻组分别为（2.75±0.39）小时、（3.82±0.42）个月、（4.09±1.58）分。三组患者手术时间、骨折愈合时间及VAS评分比较，差异均无统计学意义（P＞0.05）。正常组和外翻组Neer评分分别为（87.14±6.48）分和（84.31±9.05）分，明显高于内翻组的（75.93±9.77）分（P＜0.05）。内翻组发生并发症4例，正常组2例，外翻组未发生并发症。
肱骨近端骨折术后初始颈干角大于127°的锁定钢板内固定可减少并发症，改善肩关节功能，获得较好的治疗效果。
