Comparative Study On Preventive Measures Of Shoulder Stiffness After Proximal Humerus Fracture

Objective: To observe the clinical effect of different interventions on the prevention of shoulder stiffness after internal fixation of proximal humerus fracture.Methods: A total of 80 cases of proximal humerus fracture treated with locked plate internal fixation in hospital between October 2018 and November 2021 were included as selected samples in this study,including 59 cases of fall injury,9 cases of impact injury,7 cases of car accident injury,and 5 cases of fall injury.Patients without intraoperative intervention were included in group A(control group);The patients with intraoperative anti-adhesion membrane were included in group B(anti-adhesion membrane group).Intraoperative periarticular steroid hormone injection was included in group C(injection group);Intraoperative anti-adhesion membrane combined with periarticular steroid hormone injection was included in group D(comprehensive intervention group).The four groups of patients were treated with the same functional exercise method after surgery.Age,gender,injury mechanism and fracture type were recorded as basic data: a total of 24 cases were recorded in the control group,including 6 males,18 females,6 cases of NeerⅡ,13 cases of NeerⅢ,5 cases of NeerⅣ,14 cases of left shoulder and 10 cases of right shoulder,with an average age of(59.5±16.1)years.There were 21 cases in the anti-adhesion membrane group,including 6 males and 15 females,8 cases of Neer type Ⅱ,9 cases of Neer type Ⅲ,4 cases of Neer type Ⅳ,12 cases of left shoulder and 9 cases of right shoulder,with an average age of(58.3±15.0)years.There were 19 patients in the injection group,including 5 males and 14 females,8 Neer type Ⅱ,7 Neer type Ⅲ,4 Neer type Ⅳ,13 left shoulder and 6 right shoulder,with an average age of(61.9±15.9)years.In the comprehensive intervention group,there were a total of 16 cases,including 5 males,11 females,5 cases of NeerⅡ,7 cases of NeerⅢ,4 cases of NeerⅣ,10 cases of left shoulder and 6 cases of right shoulder.The average age was(61.6±11.6)years.Operative time,intraoperative blood loss,length of hospital stay,postoperative complications,postoperative visual analogue pain score(VAS)and Constant-Murley score of shoulder joint were collected and recorded.Results: All 80 patients were followed up for more than 9 months(9-12 months).Four groups of patients with baseline data(gender,age,injury parts and injury mechanism)and perioperative data(fracture type,operation time,intraoperative blood loss,hospital stay)comparative differences had no statistical significance(P 0.05),comparable.Four groups of 1 month,3 months postoperatively in patients with shoulder joint Constant-Murley score is statistically significant(P 0.001),irrespective of the intraoperative preventive measures,early postoperative shoulder joint function were superior to control group,which the score,the optimal comprehensive intervention group.At the last follow-up,there were no significant differences in VAS pain score and Constant-Murley score of shoulder joint among the four groups.Complications: 1 patient in the anti-adhesion membrane group developed fat liquefaction in the postoperative incision.At the last follow-up,there were 2 cases of acromial impingment in the control group and 1 case of humeral head varus in the injection group.Conclusions:1.In patients with proximal humerus fracture,early shoulder joint function is limited to varying degrees after surgery,which needs clinical attention.2.In the treatment of proximal humerus fracture with open reduction locking plate,the application of anti-adhesion membrane and periarticular steroid injection can effectively improve the motor function of the shoulder joint in the early postoperative period to varying degrees,but compared with the application of single preventive measure,the application of anti-adhesion membrane and periarticular steroid injection is better.Early postoperative shoulder pain and mobility were improved.3.The causes of shoulder stiffness after proximal humerus fracture are complex,and there are many influencing factors,so we need to further explore the preventive measures of shoulder stiffness after surgery.