肱骨近端骨折内固定下方盂肱半脱位及相关因素（开放获取）

Inferior glenohumeral subluxation following plate internal fixation of proximal humerus fractures and related factors (OA)

摘要:

[目的] 分析影响肱骨近端骨折钢板内固定术后下方?肱半脱位的相关因素。[方法] 回顾分析 2018 年 6 月—2021 年 6 月 152 例肱骨近端骨折钢板内固定术后患者的临床资料，采用单因素比较、多因素逻辑回归分析术后发生肩下方半脱位的相关因素。[结果] 所有患者均顺利完成手术。术后 1 周根据站立位肩关节正位 X 线片确诊 58 例存在肩下方半脱位 （半脱位组），占比 38.2%；94 例无半脱位（无半脱位组），占比 61.8 %。半脱位组立即给予前臂吊带高位悬吊，并进行三角肌肌力恢复训练，即主、被动耸肩锻炼。1 个月随访时 57 例半脱位消失。单项因素比较，半脱位组 Neer IV 型骨折 [III/IV, (11/47) vs (82/ 12), P＜0.001]、术前存在半脱位 [是/否, (28/30) vs (6/88), P＜0.001]、采用肌间沟入路 [肌间沟/劈三角肌, (44/14) vs (55/39), P=0.030] 的比例显著高于未脱位组，脱位组手术时间 [(123.9±35.6) min vs (75.6±20.4) min, P＜0.001] 显著长于未脱位组。多因素逻辑分析显示，手术时间长 （OR=3.133, P＜0.001）、术前存在半脱位 （OR=2.550, P＜0.001）、Neer 分型 IV 型骨折占比高 （OR=2.347, P= 0.023）、肌间沟入路 （OR=1.956, P＜0.001） 是肩下方半脱位发生的独立危险因素。[结论] 肱骨近端骨折钢板内固定术后发生下方盂肱半脱位是常见现象，预后良好。肱骨近端骨折分型严重、术前有下方盂肱半脱位、手术时间长和肌间沟入路是肱骨近端骨折钢板内固定术后发生下方盂肱半脱位的重要因素。

Abstract:

[Objective] To analyze the characteristics and related factors of inferior glenohumeral subluxation (IGHS) after plate internal fixation of proximal humerus fractures. [Methods] A retrospective study was done on 152 patients who underwent open reduction and internal fixation (ORIF) with proximal humerus locking plate (PHLP) for proximal humeral fractures in our department from June 2018 to June 2021. The characteristics and related factors of IGHS were analyzed by univariate comparison and multivariate logistic regression. [Results] All patients had ORIF conducted smoothly, however, 58 patients (38.2%) of them were confirmed as IGHS, and the remaining 94 patients (61.8%), were proved non-IGHS based on of standing anteroposterior shoulder X-ray taken 1 week after operation. The patients in the IGHS group were immediately given high-position suspension with forearm sling, and deltoid muscle strength training, namely active and passive shrug exercise. At 1 month after ORIF, 57 patients with IFHS got subluxation disappeared. Regarding to univariate comparison, the IGHS group proved significantly higher ratio than the non-IGHS group in term of Neer type IV fracture [III/IV, (11/47) vs (82/12), P＜ 0.001], subluxation before surgery [yes/no, (28/30) vs (6/88), P＜0.001], deltopectoral approach [deltopectoral / deltoid splitting, (44/14) vs (55/39), P=0.030], and the former consumed significantly longer operation time than the latter [(123.9±35.6) min vs (75.6±20.4) min, P＜ 0.001]. As results of multifactor logic regression, the longer operation time (OR=3.133, P＜0.001), subluxation before ORIF (OR=2.550, P＜ 0.001), Neer type IV fractures (OR=2.347, P=0.023), and deltopectoral approach (OR=1.956, P＜0.001) were the independent risk factors for IGHS. [Conclusion] The IGHS after ORIF with PHLP for proximal humerus fracture is a common phenomenon with good prognosis. The most important factors related to IGHS after plate internal fixation are severe fracture types, inferior glenohumeral subluxation before operation, long operation time and deltopectoral approach.