| Objectives To investigate the influence factors with humerus head varus of proximal humeral fracture surgery prevent those factors; improve the function of shoulder joint after fracture operation.Methods From March 2008 to March 2013, a retrospective survey analysis on the Second Hospital of Tangshan, which is in Hebei Province, has gone for internal fixation of proximal humerus fractures surgery and received follow-up of 58 patients, including34 females and 24 males; the age ranged from 18 to 76 years old, the average age(54.61±6.65) years old. Be grouped according to different factors, through access to medical records and follow-up, to investigate the influence factors with humerus head varus of proximal humeral fracture after operation, what factors are summarized in the closely associated with the humerus head varus deformity, prevention of these factors, improve the activity of shoulder joint function after fracture operation. SPSS 19.0 statistical software package for data entry and processing, based on different data and observe indicators, measurement data is represented by x ±s, χ2 test using univariate analysis,P<0.05 indicated the difference was statistically significant. There are statistically significant factors into Logistic regression analysis, analysis the factors which are independent risk factors of humerus varus deformity.Results 58 cases were followed up for 11 to 35 months, with an average follow-up time(18.57±3.25) months. All fractures were healed, healing time is 9 to 21 weeks, and the average healing time was 14.3 weeks. This study did not appear fracture nonunion,neurovascular injury; none of the humerus head necrosis phenomenon, humerus head varus deformity healing within nine cases, two cases of screw penetration of the articular surface, one case because of the greater tuberosity moves appears impingement, one case of wound surface infection after active dressing cured. Constant-Murley shoulder joint score: the humerus head varus group 70 points, the humerus head no varus group 82points; Neer shoulder joint score: the humerus head varus group 63 points, the humerus head no varus group 80 points. Postoperative the humerus head varus group and postoperative the humerus head no varus group in age, bone quality, fracture type,surgical approach was not statistically significant(P>0.05). 1 Shoulder externally rotated position injury patients with humerus head varus proportion(23.53%) is higher than the internal rotation injury patients(4.17%), P=0.046<0.05, the difference was statistically significant; the application of non-locking plate postoperative the humerus head varus proportion(16.70%) is higher than the application of locking plates patients(15.00%),the difference was statistically significant; Preoperative medial cortical bone defects in patients with humerus head varus proportion(25.90%) than in patients with no defects(6.50%), P=0.046<0.05, the difference was statistically significant; There were no patients with humerus screw placement the humerus head varus percentage(28.00%) is higher than the humerus screw placement in patients(6.10%), P=0.031<0.05, the difference was statistically significant; No bone graft surgery in patients with humerus head varus proportion(26.92%) than in patients with bone graft(6.25%), P=0.036<0.05,the difference was statistically significant; Preoperative the humeral neck shaft angle<125°or>145°of the patients emerge the humerus head varus proportion(30.80%) is higher than the humeral neck shaft angle of 125°~145°proportion(3.10%), P=0.008<0.05,the difference was statistically significant. 2 Non-locking plate, preoperative medial cortical bone defect, no screw fixation of humerus distance, surgery humeral neck shaft angle<125°or>145°is closely related to the occurrence of postoperative the humerus head varus deformity(P<0.05), is humeral head turned independent factors. No bone graft factor and externally rotated position-adduction type fracture has certain correlation with humerus head varus deformity(P>0.05), but is not an independent prognostic factor.Conclusions 1 The main factors humeral fractures postoperative the humerus head varus is the use of non-locking plate fixation, preoperative lateral cortical bone defect,surgery without the humerus screw placement from the medial column and surgery from the humeral neck shaft angle malreduction. 2 Postoperative humerus head varus will lead to fracture healing prolonged and shoulder function is limited. Therefore, prevention of varus deformity of the humerus head is particularly important in joint function. 3Recovery within the medial cortex access column supports and into the humerus from the screws, if necessary, is bone, which can effectively prevent displacement of the humerus head varus deformity. |
PDF Full Text Request