Correlation between function and imaging indexes after anatomic locking plate for proximal humeral fractures
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摘要:
目的探索解剖锁定钢板（ALP）治疗肱骨近端骨折（PHF）术后功能与影像学指标之间的相关性。 方法回顾性分析2016年6月~2019年1月本院收治的120例PHF患者，根据患者的Neer分型将其分为二部分骨折组（n=28）、三部分骨折组（n=60）和四部分骨折组（n=32）。所有患者均采用ALP治疗，记录患者ALP的手术时间和术中出血量；术后1年，X线片检查患者颈干角丢失角度和肱骨头丢失高度，检查患肢肩关节的活动度，采用Constant-murley评分评估肩关节功能，视觉模拟评分评估术后疼痛程度，Pearson相关性分析PHF患者术后肩关节功能与颈干角丢失角度和肱骨头丢失高度之间的相关性。 结果随着Neer分型增加，PHF患者术中出血量明显增加（P < 0.05），术后颈干角丢失角度和肱骨头高度丢失明显增加（P < 0.05），肩关节前屈、外旋、内旋角度明显下降（P < 0.05），Constant评分明显降低（P < 0.05），视觉模拟评分明显增加（P < 0.05）；Pearson相关性分析显示，PHF患者术后肩关节前屈、外旋、内旋、Constant评分与术后颈干角丢失角度和肱骨头高度呈显著的负相关关系（P < 0.05）。 结论PHF患者ALP术后肩关节活动度和功能与颈干角、肱骨头高度变化具有显著的相关性。 Abstract:ObjectiveTo explore the correlation between function and imaging indexes after anatomic locking plate (ALP) for proximal humeral fractures (PHF). MethodsA retrospective analysis was performed on the 120 PHF patients who were admitted to the hospital from June 2016 to January 2019. According to Neer classifications, they were divided into two-part fracture group (n=28), three-part fracture group (n=60) and four-part fracture group (n=32). All were treated with ALP. The operation time and intraoperative blood loss were recorded. At 1 year after surgery, loss angle of neck shaft angle, loss height of humeral head and range of motion (ROM) of effected shoulder joints were examined by X-ray films. The shoulder function was evaluated by Constant-murley scores. The postoperative pain was evaluated by scores of VAS. The correlation between postoperative function and imaging indexes in PHF patients was analyzed by Pearson correlation analysis. ResultsWith the increase of Neer classification, intraoperative blood loss was significantly increased in PHF patients (P < 0.05), postoperative loss angle of neck shaft angle and loss height of humeral head were significantly increased (P < 0.05), anteflexion, external and internal rotation angles of shoulder joints and Constant scorewere significantly decreased (P < 0.05), and VAS score was significantly increased (P < 0.05). Pearson correlation analysis showed that postoperative anteflexion, external rotation and internal rotation of shoulder joints, and Constant score were significantly negatively correlated with postoperative loss angle of neck shaft angle and loss height of humeral head (P < 0.05). ConclusionROM of shoulder joints is significantly correlated with changes in neck shaft angle and height of humeral head in PHF patients after ALP. -
图 1 PHF患者术后的影像学参数
A~D来源于同一患者.A:术前; B:术后1周; C:术后3月; D:术后1年.
Figure 1. Postoperative imaging parameters in PHF patients.
表 1 PHF患者手术的一般情况
Table 1. General conditions of surgery in PHF patients (Mean±SD)
组别 手术时间（min） 术中出血量（mL） 二部分骨折组（n=28） 92.72±21.43 125.72±21.53 三部分骨折组（n=60） 96.85±22.81 176.64±30.87* 四部分骨折组（n=32） 105.26±26.54 238.47±57.22*# F 2.293 66.107 P 0.106 < 0.001 *P < 0.05 vs二部分骨折组; #P < 0.05 vs三部分骨折组. PHF: Proximal humeral fractures. 
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表 2 PHF患者术后的影像学参数
Table 2. Postoperative imaging parameters of PHF patients (Mean±SD)
组别 颈干角丢失角度（°） 肱骨头高度丢失（mm） 二部分骨折组（n=28） 2.63±0.71 1.67±0.42 三部分骨折组（n=60） 4.25±1.22* 2.52±0.68* 四部分骨折组（n=32） 6.37±1.54*# 3.74±0.91*# F 71.256 66.819 P < 0.001 < 0.001 *P < 0.05 vs二部分骨折组; #P < 0.05 vs三部分骨折组.
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表 3 两组PHF患者术后肩关节的活动度
Table 3. ROM of shoulder joints in PHF patients(°, Mean±SD)
组别 前屈 外旋 内旋 二部分骨折组（n=28） 147.25±21.58 47.46±6.43 45.71±5.01 三部分骨折组（n=60） 134.76±15.64* 44.51±6.60* 42.80±4.93* 四部分骨折组（n=32） 127.22±13.50*# 40.29±5.52*# 40.03±4.86*# F 10.908 9.987 9.919 P < 0.001 < 0.001 < 0.001 *P < 0.05 vs二部分骨折组; #P < 0.05 vs三部分骨折组.
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表 4 各组ONFH患者术后髋关节VAS和HSS评分
Table 4. Postoperative scores of VAS and HSS in ONFH patients of each group (score, Mean±SD)
组别 Constant评分 VAS 二部分骨折组（n=28） 88.44±7.63 1.24±0.31 三部分骨折组（n=60） 84.49±9.58 1.37±0.30 四部分骨折组（n=32） 80.42±10.21*# 1.45±0.32* F 5.517 3.529 P 0.005 0.033 *P < 0.05 vs二部分骨折组; #P < 0.05 vs三部分骨折组.
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表 5 PHF患者术后功能与术后影像学之间的相关性分析
Table 5. Correlation between postoperative function and imaging in PHF patients
指标 颈干角丢失角度 肱骨头高度丢失 前屈 r=-0.421* r=-0.382* 外旋 r=-0.417* r=-0.364* 内旋 r=-0.406* r=-0.357* Constant评分 r=-0.434* r=-0.387* VAS r=0.121# r=0.165# *P < 0.001; #P>0.05
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