肱骨近端角度变化对锁定钢板内固定治疗肱骨近端骨折预后的影响

摘要

目的：探讨肱骨后倾角、颈干角变化对锁定钢板内固定治疗肱骨近端骨折预后的影响。方法2012年9月至2013年10月，采用肱骨近端锁定内固定系统（PHILOS）治疗52例肱骨近端骨折患者，其中38例获得12个月以上的随访，记录患者术后并发症并评估患者疼痛视觉模拟评分（VAS）及Constant‐Murley肩关节评分。所有患者术后3 d内行双侧肱骨全长CT检查，在三维CT 重建图像上测量双侧肱骨后倾角及颈干角。比较患侧与健侧肱骨后倾角和颈干角并将肱骨近端骨折患者分为后倾角增加组、后倾角减小组及颈干角增大组、颈干角减小组。结果患侧与健侧肱骨后倾角差异无统计学意义，但患侧肱骨颈干角显著大于健侧。末次随访时，肱骨颈干角增加组与减小组VAS评分、并发症发生率及Constant‐M urley肩关节评分均无统计学差异；肱骨后倾角减小组并发症发生率明显低于后倾角增大组，而Constant‐M urley肩关节评分显著高于后倾角增大组。结论与健侧相比，患侧肱骨颈干角改变对锁定钢板内固定患者预后影响不大，但肱骨后倾角较健侧增大是患者预后的危险因素之一。%Objective To explore the influence of the changes of humeral retroversion angle (HRA) and neck‐shaft angle (NSA ) on the prognosis of proximal humeral fractures treated with locking plate . Methods From September 2012 to October 2013 ,52 patients of proximal humeral fracture were treated with the proximal humeral internal locking system (PHILOS) ,and 38 patients received the follow‐up more than 12 months .During the follow‐up ,the Constant‐Murley shoulder score ,visual analogue scale (VAS) and complication rate were evaluated .All patients received the CT scanning on the bilateral whole humerus in 3 days after operation ,three‐dimensional CT reconstruction were applied for measuring HRA and NSA .The patients were divided into NSA increasing group and NSA reducing group as well as HRA increasing group and HRA reducing group by comparing HRA and NSA of the affected shoulders with them of the contralateral shoulders .Results There were no statistically significant difference of HRA between the affected shoulders and the contralateral shoulders .However ,NSA of the affected shoulder was significantly larger than it of the contralateral shoulder . There was no significant difference between the NSA increasing group and the NSA reducing group in VAS ,the complication rate and Constant‐Murley shoulder score . While the complication rate of HRA reducing group were lower than it of HRA increasing group ,and Constant‐Murley shoulder score of HRA reducing group were higher than it of HRA increasing group .Conclusion The increasing HRA is the risk factor of the prognosis of proximal humeral fractures treated with PHILOS .