Study on the relationship between the medial column support and the effect of treatment by open reduction and internal fixation of the proximal humerus fractures / 中华骨科杂志

ABSTRACT

Objective By measuring the height loss of humeral head and combined with the clinical curative effect of the contrast,to investigate the correlation between the medial column support with locking proximal humerus plate fracture efficacy.Methods From June 2009 to August 2012,70 cases with proximal humeral fractures underwent internal fixation with locking plates were retrospectively analyzed.Based on the presence of medial support,all the cases were divided into 2 groups according to the proximal humeral fracture block.By measuring the change of postoperative loss of lateral humeral head height and evaluating the shoulder function,to comparative analysis of the effect of medial column support in the recovery reduction maintenance and patient function.Results There were 66 cases access the follow-up of this study,loss of 4 cases in follow-up,with an average follow-up period of 13 months (range,10-18).Thirty-eight cases of medial support group loss to follow-up 3,and no medial support group 32 cases lost to follow-up 1.Intraoperative iliac bone graft in 7 cases,including 3 cases of medial support and 4 cases of no inner support.All cases achieved clinical bone healing in the last follow-up time.Medial support can effectively reduce the degree of reduction and loss,and the average height loss of humerus head is 1.4mm (standard deviation.1.0 mm).The average height loss of humerus bead is 6.2 mm (standard deviation.3.7 mm) in no support group,which was substantially higher than the medial support group.The inner support group had no obvious complications,and in the absence of 31 cases of medial support,3 cases showed screws wear out of the articular surface,2 cases showed screws loose.In 3 cases of screw penetrating the articular surface were underwent two operation to remove or replace screws.In the medial support group,according to the Neer centesimal system score,the results were excellent in 32 cases,good in 3.The excellent and good rate was 100％.In the no medial support group,the results were excellent in 25 cases,good in 1,and fair in 5.The excellent and good rate was 83.8％.Conclusion Locking plate in tension side does not fully support the humeral head.The medial column support can obtain better maintenance of reduction and postoperative effect through improving the medial column mechanical stability.