CAJ | 학술논문

目的探讨肱骨近端骨折术后螺钉穿出肱骨头的发生率及其影响因素和预防对策.方法回顾性分析2006年6月至2012年6月采用切开复位锁定钢板内固定治疗的187例肱骨近端骨折患者资料,男78例,女109例;年龄18～88岁,平均55.9岁.根据患者随访期间X线片判断是否存在螺钉穿出肱骨头,并以此为因变量;以性别、年龄、Neer骨折分型、内侧柱粉碎、骨密度、受伤至手术时间、植骨、复位程度、肱骨头螺钉数目、内侧柱支撑作为自变量,先行各因素的单因素logistic回归分析.然后对P ＜0.05的因素进行多因素logistic逐步回归分析. 结果 187例患者术后平均随访17.8个月(10～45个月),共有27例发生螺钉穿出肱骨头,发生率为14.4％.单因素logistic回归分析发现Neer骨折类型、内侧柱粉碎、植骨、复位程度、肱骨头螺钉数目、内侧柱支撑、内侧柱粉碎×内侧柱支撑的差异有统计学意义(P＜0.05).经多因素logistic逐步回归分析发现:Neer三部分/二部分骨折差异有统计学意义[P=0.028,OR =4.406,95％ CI(1.176 ～ 16.515)],Neer四部分/二部分骨折差异有统计学意义[P=0.004,OR=7.799,95％ CI(1.924 ～31.620)]内侧柱粉碎的差异有统计学意义[(P=0.008,OR=0.287,95％ CI(0.114～0.718)]. 结论影响肱骨近端骨折术后螺钉穿出肱骨头的主要预后因素是骨折类型和内侧柱粉碎,应根据患者具体情况制定最优的方案,减少螺钉穿出肱骨头的发生.
목적 탐토굉골근단골절술후라정천출굉골두적발생솔급기영향인소화예방대책.방법 회고성분석2006년6월지2012년6월채용절개복위쇄정강판내고정치료적187례굉골근단골절환자자료,남78례,녀109례;년령18～88세,평균55.9세.근거환자수방기간X선편판단시부존재라정천출굉골두,병이차위인변량;이성별、년령、Neer골절분형、내측주분쇄、골밀도、수상지수술시간、식골、복위정도、굉골두라정수목、내측주지탱작위자변량,선행각인소적단인소logistic회귀분석.연후대P ＜0.05적인소진행다인소logistic축보회귀분석. 결과 187례환자술후평균수방17.8개월(10～45개월),공유27례발생라정천출굉골두,발생솔위14.4％.단인소logistic회귀분석발현Neer골절류형、내측주분쇄、식골、복위정도、굉골두라정수목、내측주지탱、내측주분쇄×내측주지탱적차이유통계학의의(P＜0.05).경다인소logistic축보회귀분석발현:Neer삼부분/이부분골절차이유통계학의의[P=0.028,OR =4.406,95％ CI(1.176 ～ 16.515)],Neer사부분/이부분골절차이유통계학의의[P=0.004,OR=7.799,95％ CI(1.924 ～31.620)]내측주분쇄적차이유통계학의의[(P=0.008,OR=0.287,95％ CI(0.114～0.718)]. 결론 영향굉골근단골절술후라정천출굉골두적주요예후인소시골절류형화내측주분쇄,응근거환자구체정황제정최우적방안,감소라정천출굉골두적발생.
Objective To analyze the incidence of screw penetration after surgery for proximal humeral fractures (PHF) and to explore its prognostic factors and preventive countermeasures.Methods From June 2006 to June 2012,187 PHF patients were treated with open reduction-internal fixation with locking plates at our department.They were 78 males and 109 females,18 to 88 years of age (average,55.9 years).Screw penetration was identified according to the follow-up X-ray films of the patients' shoulders.In our analysis,screw penetration was taken as the dependent variable while gender,age,Neer fracture type,medial cortex fracture,bone mineral density,time interval from trauma to surgery,bone graft,reduction quality,screw number in the humeral head,and medial column support were taken as covariates.Univariate logistic regression analysis was adopted to pick up the factors with P ＜ 0.05 which were then analyzed by multiple stepwise logistic regression.Results All the patients were followed up for a mean time of 17.8 months (from 10 to 45 months).Screw penetration happened in 27 patients (incidence,14.4％).The univariate logistic regression analysis showed that Neer fracture type,medial cortex fracture,bone graft,reduction quality,screw number in the humeral head,and medial column support had a significant association with screw penetration (P ＜ 0.05).The multiple stepwise logistic regression showed that there were significant differences between Neer 3-part and 2-part fractures [P =0.028,OR =4.406,95％ CI(1.176 ～ 16.515)],4-part and 2-part fractures [P =0.004,OR =7.799,95％ CI(1.924 ～ 31.620)] respectively.Medial cortex fracture [P =0.008,OR =0.287,95％ CI (0.114-0.718)] was a key factor affecting screw penetration.Conclusions Neer fracture type and medial cortex fracture may be the chief prognostic factors affecting screw penetration after surgery for PHF.The best treatment should be made on the basis of individuals to reduce the incidence of screw penetration.