Study On The Treatment Of Proximal Humerus Fractures With Double Plate Technique Under The Guidance Of The Theory Of "Differentiation Of Stability And Treatment"

Objective: Fractures of the proximal humerus are one of the most common types of fractures in orthopaedics,with an incidence of 4%-5%.Such fractures are more common in elderly patients with osteoporosis,and are more common in low-energy cord injuries.Entering aging,its incidence is increasing year by year.For unstable proximal humerus fractures,open reduction and locking plate internal fixation are mainly used in clinical treatment.However,due to reasons such as osteoporosis and lack of medial support,especially three-and four-part fractures,the frequency of postoperative complications such as poor reduction,collapse of the humeral head,and screw cutout remains high.There are many ways,this study will use different methods to explore the effect of the double plate technique of the PHILOS plate combined with the lateral intertuberous sulcus plate in the treatment of proximal humeral fractures.Methods: In the first part,the biomechanical characteristics of the PHILOS plate combined with the lateral intertuberous sulcus plate combined with the double plate technique of the medial column-missing proximal humerus fracture were investigated by finite element analysis.After establishing a three-dimensional finite element model of proximal humerus fracture with missing medial column,the full screw PHILOS plate in group A,the supporting screw missing PHILOS plate and auxiliary plate in group B,and the full screw PHILOS plate and auxiliary plate in group C were implanted into the proximal humerus.In the fracture model,horizontal,compressive,and rotational loads were then applied to the humerus model,and biomechanical properties were assessed by recording and comparing fracture end displacement and angular changes,the structural stiffness of the implant,and stress distribution.The second part discusses the clinical treatment effect of the PHILOS plate combined with the lateral intertuberous groove plate in the treatment of proximal humeral fractures through the analysis of case data.The case data of 30 patients with proximal humerus fractures admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2019 to December 2021 were collected,of which 15 cases were treated with double plate technique and 15 cases were treated with PHILOS plate internal fixation.The average operation time,fracture healing time,humeral neck-shaft angle,Neer score of shoulder joint at 3 and 6 months after operation,VAS score at 2 weeks after operation,and patient’s subjective satisfaction were compared between the two groups.treatment effect.Result:The results of the finite element analysis in the first part show that: among the three groups of models,the displacement values of the fracture ends,the angle values and the maximum equivalent stress values of the three groups of models ABC gradually decrease,and the compressive stiffness and rotational stiffness values gradually increase.Therefore,the group C The implants in the double-steel plate group had the highest structural stiffness and the strongest stability,and the cloud map showed that the C group greatly dispersed the stress and reduced the maximum stress.The results of the second part of the clinical study showed that the single-plate group was better than the double-plate group in terms of operation time,and the difference was statistically significant(P<0.05).The difference was statistically significant(P<0.05),the Neer score at 3 months and 6 months after the operation was better than that in the single-plate group,and the difference was statistically significant(P<0.05).The angle comparison of the double plate group was better than that of the single plate group,and the difference was statistically significant(P<0.05).Conclusion:The first part simulates the biomechanical stress of each model under physiological and test conditions through finite element analysis,and analyzes the stress distribution characteristics.The double-plate group of the PHILOS plate combined with the lateral plate of the internodal groove has the strongest stability and the best biomechanical properties.Compared with the traditional PHILOS single plate,it provides effective lateral and medial support,has better stability,and can effectively Reduce the risk of internal fixation failure.The results of the second part of the clinical study showed that the double plate group had advantages in healing time,postoperative functional recovery,shoulder joint Neer score,and postoperative neckshaft angle recovery compared with the traditional simple PHILOS plate,but the operation time was slightly longer than that of the single plate.Therefore,the double plate technique In the treatment of more complex three-and four-part fractures of the proximal humerus,it can provide additional support and strengthen the fixation.Patients can perform early functional training,obtain satisfactory shoulder joint function results,and avoid complications such as humeral head inversion and internal fixation cutting out.