Postoperative complications of complex proximal humeral fractures after treated with proximal humeral internal locking system plate fixation

doi:10.3969/j.issn.2095-4344.2013.48.014

Abstract

Abstract:

BACKGROUND: Proximal humeral internal locking system fixation for complex humeral fractures via deltoid splitting approach provides good clinical results, but certain complications still existed.
OBJECTIVE: To explore the postoperative complications and the related risk factors for displaced three-part and four-part fractures of proximal humerus treated with proximal humeral internal locking system fixation via deltoid-splitting approach, and to propose the corresponding countermeasures.
METHODS: 106 cases with displaced three-part and four-part fractures of proximal humerus were retrospectively analyzed. The relationship between postoperative complications and the related risk factors was analyzed with Logistic regression analysis.
RESULTS AND CONCLUSION: A total of 81 patients were followed-up for 12 to 30 months. The mean Constant score at 12 months after operation was (76.57±4.70) points. The postoperative complications occurred in 31 patients (38.3%) of which impingement syndrome involved in 16 cases (19.8%), head-shaft angle loss in six cases (7.4%), head-shaft angle loss combined with screws cut-out in two cases (2.5%), pure screws cut-out in two cases (2.5%), humeral head necrosis in two cases (2.5%), fat liquefaction in five cases (6.2%). Single factor analysis showed that there were significant differences in the superiorly located greater tuberosity, superiorly located plate and Neer classification between impingement group and un-impinged group (P < 0.05). There were statistically significant differences in age, postoperative medial cortical defects and Neer classification between head-shaft angle loss group and un-loss group (P< 0.05). By means of logistic regression analysis, the superiorly located greater tuberosity, superiorly located plate and Neer classification were the individual predictors for postoperative impingement syndrome; postoperative medial cortical defect and Neer classification were the individual predictors for postoperative head-shaft angle loss.

Key words: humerus, humeral fractures, fracture fixation, internal, deltoid muscle, internal fixators

CLC Number:

R318

Ma Fu-yuan, Yang Tie-yi, Jiang Rui, Zhang Yan, Liu Yue, Shao Jin . Postoperative complications of complex proximal humeral fractures after treated with proximal humeral internal locking system plate fixation[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(48): 8381-8387.

Figures/Tables 5

2.1 参与者数量分析因患者搬家、疾病、死亡、合并肩关节其他部位骨折等原因，具备完整随访资料并纳入本研究的病例共81例，男33例，女48例；年龄41-83岁，平均66.1岁；获得随访12-30个月，平均19.2个月。 2.2 随访结果内固定后12个月随访时肩关节Constant评分平均为(76.57±4.70)分。31例患者出现并发症(38.3%)，其中肩峰撞击16例(19.8%)，头干角丢失6例(7.4%)，头干角丢失合并螺钉穿出关节面2例(2.5%)，螺钉穿出关节面2例(2.5%)，肱骨头坏死2例(2.5%)，切口脂肪液化5例(6.2%)，无腋神经损伤，无骨不愈合，无内固定物松动断裂，无深部感染。切口脂肪液化患者经换药处理后痊愈。内固定后肩峰撞击的患者Constant评分为73.38分，而无撞击的患者为77.35分(P < 0.05)，内固定后头干角丢失的患者Constant评分为73.13分，而无丢失的患者为76.95分(P < 0.05)，螺钉初始穿出关节面或继发切出对Constant得分产生明显影响：66.75分和77.08分 (P < 0.05)，肱骨头坏死对Constant评分差异无显著性意义(76.67分和72.50分，P > 0.05)。 2.3 并发症相关危险因数分析因肱骨头坏死和螺钉穿出关节面病例数较少，未进行危险因素统计学分析。单因素分析显示，内固定后钢板位置过高的患者出现肩峰撞击的比例(43.8%)高于钢板位置不高的患者(13.8%)，内固定置入后大结节位置高的患者出现肩峰撞击的比例(41.2%)高于大结节位置不高的患者(13.8%)、四部分骨折患者出现肩峰撞击的比例(30%)高于三部分骨折的患者(9.8%)；内固定置入后内侧骨皮质缺损患者出现术后头干角丢失的比例(25.0%)高于无缺损患者(5.0%)，四部分骨折的患者出现术后头干角丢失的比例(17.5%)高于三部分骨折的患者(2.4%)，年龄≥65岁的患者出现术后头干角丢失的比例(15.4%)高于年龄<65岁的患者(4.8%)，差异均有显著性意义(P < 0.05)，见表1。"

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