Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Bone Joint J. 2020 Dec;102-B(12):1629-1635. doi: 10.1302/0301-620X.102B12.BJJ-2020-0070.R1.
The aim of this study was to explore why some calcar screws are malpositioned when a proximal humeral fracture is treated by internal fixation with a locking plate, and to identify risk factors for this phenomenon. Some suggestions can be made of ways to avoid this error.
We retrospectively identified all proximal humeral fractures treated in our institution between October 2016 and October 2018 using the hospital information system. The patients' medical and radiological data were collected, and we divided potential risk factors into two groups: preoperative factors and intraoperative factors. Preoperative factors included age, sex, height, weight, body mass index, proximal humeral bone mineral density, type of fracture, the condition of the medial hinge, and medial metaphyseal head extension. Intraoperative factors included the grade of surgeon, neck-shaft angle after reduction, humeral head height, restoration of medial support, and quality of reduction. Adjusted binary logistic regression and multivariate logistic regression models were used to identify pre- and intraoperative risk factors. Area under the curve (AUC) analysis was used to evaluate the discriminative ability of the multivariable model.
Data from 203 patients (63 males and 140 females) with a mean age of 62 years (22 to 89) were analyzed. In 49 fractures, the calcar screw was considered to be malpositioned; in 154 it was in the optimal position. The rate of malpositioning was therefore 24% (49/203). No preoperative risk factor was found for malpositioning of the calcar screws. Only the neck-shaft angle was found to be related to the risk of screw malpositioning in a multivariate model (with an AUC of 0.72). For the fractures in which the neck-shaft angle was reduced to between 130° and 150°, 91% (133/46) of calcar screws were in the optimal position.
The neck-shaft angle is the key factor for the appropriate positioning of calcar screws when treating a proximal humeral fracture with a locking plate. We recommend reducing the angle to between 130° and 150°. Cite this article: 2020;102-B(12):1629-1635.
本研究旨在探讨在使用锁定钢板内固定治疗肱骨近端骨折时，为何有些钢板螺钉会发生位置不良，并确定导致这种现象的危险因素。我们可以提出一些避免这种错误的方法。
我们使用医院信息系统回顾性地确定了 2016 年 10 月至 2018 年 10 月在我院治疗的所有肱骨近端骨折患者。收集了患者的医疗和影像学数据，并将潜在的危险因素分为两组：术前因素和术中因素。术前因素包括年龄、性别、身高、体重、体重指数、肱骨近端骨密度、骨折类型、内侧铰链情况和内侧干骺端头延伸。术中因素包括术者等级、复位后颈干角、肱骨头高度、内侧支撑的恢复情况和复位质量。使用调整后的二项逻辑回归和多变量逻辑回归模型来确定术前和术中的危险因素。曲线下面积（AUC）分析用于评估多变量模型的判别能力。
分析了 203 例患者（63 例男性和 140 例女性）的数据，平均年龄为 62 岁（22 至 89 岁）。在 49 例骨折中，钢板螺钉被认为位置不当；在 154 例中，钢板螺钉位于最佳位置。因此，位置不当的发生率为 24%（49/203）。未发现术前危险因素与钢板螺钉位置不当有关。只有颈干角在多变量模型中与螺钉位置不当的风险相关（AUC 为 0.72）。对于颈干角降低至 130°至 150°之间的骨折，91%（133/46）的钢板螺钉位于最佳位置。
在使用锁定钢板治疗肱骨近端骨折时，颈干角是钢板螺钉正确定位的关键因素。我们建议将角度减小到 130°至 150°之间。
2020；102-B（12）：1629-1635。
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