锁定钢板治疗肱骨近端骨折内侧柱支撑螺钉数与疗效的关系

摘要

目的 探讨不同数量(0~3枚)内侧柱支撑螺钉重建内侧柱支撑对锁定钢板治疗肱骨近端骨折疗效的影响.方法 行锁定钢板治疗的肱骨近端骨折患者184例,根据肱骨近端内侧柱支撑螺钉使用数量分为0枚支撑钉组(63例)、1枚支撑钉组(49例)、2枚支撑钉组(41例)和3枚支撑钉组(31例),比较4组骨折愈合情况、肱骨头高度丢失、肩关节功能、末次随访时骨折复位效果和并发症发生率.结果 末次随访时,3枚支撑钉组、2枚支撑钉组、1枚支撑钉组、0枚支撑钉组肱骨头内翻角依次为(1.74 ± 0.57)°、(1.96 ± 0.93)°、(3.28 ± 1.14)°、(6.14 ± 2.95)°,肱骨头丢失高度依次为(1.06 ± 0.84) mm、(2.92 ± 1.41) mm、(5.09 ± 2.25) mm、(6.18 ± 2.47) mm,Constant评分依次为(79.56 ± 7.83)、(76.13 ± 8.45)、(64.86 ± 7.33)、(57.64 ± 6.68),4组比较差异有统计学意义(P<0.01);术后首次测量颈干角、骨折愈合时间、并发症发生率4组比较差异无统计学意义(P>0.05).结论 采用锁定钢板治疗肱骨近端骨折中,选择2或3枚支撑钉重建内侧柱支撑可获得较满意的效果.%Objective To investigate the effects of different medial column support screw numbers (0 ~3) on the therapeutic effects of proximal humeral anatomical locking plate on proximal humeral fractures. Methods A total of 184 patients with proximal humeral fractures who were treated by proximal humeral anatomical locking plate in our hospital from January 2011 to March 2016 were enrolled in the study. According to proximal humeral medial column support screws numbers,these patients were divided into 0 screw support group (n=63),1 screw support group (n=49),2 screws support group (n=41) and 3 screws support group(n=31),then the fracture healing status,humerus head height loss,shoulder joint function,the fracture reduction effects at last follow up and incidence rate of complications were observed and compared among the four groups.Results At last follow-up,the humerus head varus angle in 3 screws,2 screws,1 screw,0 screw support groups was (1.74 ± 0.57)°,(1.96 ± 0.93)°,(3.28 ± 1.14)°,(6.14 ± 2.95)°,respectively, and the humerus head height loss was(1.06 ± 0.84) mm,(2.92 ± 1.41) mm,(5.09 ± 2.25) mm,(6.18 ± 2.47) mm,respectively,and Constant scores were (79.56 ± 7.83),(76.13 ± 8.45),(64.86 ± 7.33),(57.64 ± 6.68), respectively, there were significant differences among the four groups (P<0.01). However there were no significant differences in neck stem angle,fracture healing time, incidence rate of complication in the first detection after operation among the four groups (P >0.05). Conclusion In treatment of proximal humeral fractures by proximal humeral anatomical locking plate, to use 2 or 3 support screws to reconstruct medial column support can obtain satisfactory therapeutic effects.