肱骨近端锁定钢板治疗成人肱骨近端骨折的疗效分析

目的 探讨肱骨近端锁定钢板治疗肱骨近端骨折的临床疗效. 方法 采用肱骨近端锁定钢板治疗53例肱骨近端骨折.测量术后前后位平片患肢肱骨颈干角,内翻复位、即颈干角＜125°为A组,颈干角≥125°为B组.随访时评估记录患者肩关节功能-Constant评分、疼痛评分、并发症以及测量患侧肱骨颈干角的变化. 结果 本组患者获得6～36个月随访（平均16.2个月）.末次随访时,Constant评分均分76分、优良率71.7％,VAS疼痛评分均分2.2.A组10例患者、B组43例患者,Constant评分B组优于A组（78±14.6分vs 67±11.7分,P＜0.05）,术后肱骨头内翻角度前者明显大于后者（P＜0.05）. 结论 采用肱骨近端锁定钢板治疗成人肱骨近端骨折取得满意疗效.术中解剖复位、恢复良好的肱骨颈干角,是内固定稳定、预防术后肱骨头内翻及术后取得良好临床疗效的关键.

Clinical outcomes of proximal humeral fractures treated with locking plates in adult

Objective To evaluate the clinical outcomes of proximal humeral fractures treated with locking plates. Methods 53 cases of proximal humeral fracture were treated with locking plates. One independent examiner measured the ipsilateral humeral neck-shaft angle in the an- teroposterior radiograph obtained postoperatively. All cases were then subdivided into A group （the initial neck-shaft angle〈125°） or B group （the initial neck-shaft angle≥ 125°）. The patients＂ functional recovery, pain score, complications, and the change of the ipsilateral humeral neck-shaft angle were evaluated at the time of follow-up. Results All cases accomplished a mean 16.2 months follow-up （range from 6 to 36 months）. The mean Constant score was 76 points, with the excellent and good rates of 71.7% and the mean VAS score was 2.2 points. There were lO patients in the A group and 43 patients in the B group. The B group achieved better Constant score than the A group （78±14.6 points vs 67±11.7points, P〈0.05）. Moreover, we observed a significantly greater secondary neck-shaft angle loss in the A group （P〈0.05）. Conclusion The treatment of proximal humerus fractures using locking plates achieved satisfactory outcomes. Anatomic reduction of the humeral head and reconstruction of adequate neckshaft angle may help to enhance mechanical stability of the humeral head and prevente secondary neck-shaft angle loss. In addition, its has more like- ly to achieve good clinical outcome.