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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2022, Vol. 08 ›› Issue (05) : 296 -303. doi: 10.3877/cma.j.issn.2096-0263.2022.05.008

上肢骨折

肱骨近端骨折内固定术后影响肩关节功能的因素分析及生活质量的研究
何昌军1, 马腾1, 任程1, 李庆达1, 路遥1, 熊晨1, 杨明义1, 崔玉1, 杨娜1,†(), 许毅博1, 李明1, 李忠1, 张堃1   
  1. 1. 710054　西安交通大学附属西安市红会医院创伤骨科
  • 收稿日期:2021-05-28 出版日期:2022-10-05
  • 通信作者: 杨娜

Analysis of factors affecting shoulder function and quality of life after internal fixation of proximal humeral fractures

Changjun He1, Teng Ma1, Cheng Ren1, Qingda Li1, Yao Lu1, Chen Xiong1, Mingyi Yang1, Yu Cui1, Na Yang1,†(), Yibo Xu1, Ming Li1, Zhong Li1, Kun Zhang1   

  1. 1. Department of trauma orthopaedics, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, China
  • Received:2021-05-28 Published:2022-10-05
  • Corresponding author: Na Yang
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引用本文：

何昌军, 马腾, 任程, 李庆达, 路遥, 熊晨, 杨明义, 崔玉, 杨娜, 许毅博, 李明, 李忠, 张堃. 肱骨近端骨折内固定术后影响肩关节功能的因素分析及生活质量的研究[J]. 中华老年骨科与康复电子杂志, 2022, 08(05): 296-303.

Changjun He, Teng Ma, Cheng Ren, Qingda Li, Yao Lu, Chen Xiong, Mingyi Yang, Yu Cui, Na Yang, Yibo Xu, Ming Li, Zhong Li, Kun Zhang. Analysis of factors affecting shoulder function and quality of life after internal fixation of proximal humeral fractures[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(05): 296-303.

目的

探讨肱骨近端骨折术后影响肩关节功能恢复的相关因素及术后不同肩关节功能对患者健康相关生活质量的影响。

方法

回顾性分析2017年1月至2019年1月西安交通大学附属红会医院采用内固定手术治疗的116例肱骨近端骨折患者的资料。男53例，女63例；侧别：右侧55例，左侧61例；年龄34~82岁，平均（60±13）岁。骨折Neer分型:一部分骨折12例，二部分骨折58例，三部分骨折29例，四部分骨折17例。术后12个月随访时采用Neer肩关节功能评分评估患者肩关节功能，并根据肩关节功能分为优良组和可差组，并对两组患者年龄、性别、骨折类型、骨密度、受伤至手术时间、肩袖损伤、侧别、人工骨植骨、术后开始功能康复锻炼时间和骨折复位质量等相关影响因素进行分析。通过健康调查简表（SF-12）、简明疼痛度量表（BPI）和EQ-5D视觉模拟量表（EQ-VAS）获取两组患者生活质量相关数据，比较评价肱骨近端骨折术后不同肩关节功能患者健康相关生活质量。

结果

通过比较可能影响肩关节功能的相关风险因素得出骨折类型、骨密度、受伤至手术时间、肩袖损伤、术后开始功能康复锻炼的时间、复位质量在两组患者之间的差异具有统计学意义（P<0.05）；肩关节功能Neer评分优良率为75.9%（88/116）；肩关节功能优良组患者各项得分SF-12PCS（42.9±5.2）、SF-12MCS（47.5±6.0）、BPI-S（4.1±1.2）、BPI-I（3.6±1.1）、EQ-VAS（82.3±4.4），可差组患者各项得分SF-12PCS（30.1±3.7）、SF-12MCS（33.1±3.5）、BPI-S（6.3±1.2）、BPI-I（6.2±1.3）、EQ-VAS（72.2±5.5），并且两组患者在SF-12PCS、SF-12MCS、BPI-S、BPI-I、EQ-VAS方面统计差异均具有统计学意义（P<0.05）。

结论

骨折类型、骨密度、受伤至手术时间、肩袖损伤、术后开始功能康复锻炼的时间、复位质量等影响术后肩关节功能的恢复并且肩关节功能差对患者的身心健康及生活质量也都产生了不同程度的消极影响。

关键词: 骨折，肱骨近端, 肩关节功能, 生活质量, SF-12量表, BPI量表
Objective

To investigate the related factors affecting the recovery of shoulder function after proximal humerus fracture and the influence of different shoulder function on the patients' health-related quality of life after operation.

Methods

The data of 116 patients with proximal humerus fractures who underwent internal fixation in the Affiliated Red Society Hospital of Xi'an Jiaotong University from January 2017 to January 2019 were retrospectively analyzed. There were 53 males and 63 females. Lateral differences: right 55 cases, left 61 cases. The age was 34-82 years old, with an average of (60±13) years old. Neer classification of fracture: 12 cases of partial fracture, 58 cases of two-part fracture, 29 cases of three-part fracture, 17 cases of four-part fracture. The shoulder function of the patients was evaluated by Neer shoulder function score at the 12-month follow-up, and the patients were divided into excellent group and poor group according to the shoulder function. Age, gender, fracture type, bone mineral density, time from injury to operation, rotator cuff injury, side type, artificial bone graft, time to start functional rehabilitation exercise after surgery and quality of fracture reduction were analyzed in 2 groups. Quality of life data of patients in the two groups were obtained by Health Survey Brief Form (SF-12), Simple Pain Scale (BPI) and EQ-5D Visual Analogue Scale (EQ-VAS), and health-related quality of life of patients with different shoulder function after proximal humerus fracture was compared and evaluated.

Results

By comparing the related risk factors that may affect the function of shoulder joint, the differences of fracture type, bone mineral density, time from injury to operation, rotator cuff injury, time to start functional rehabilitation exercise after surgery, and reduction quality between the two groups were statistically significant (P<0.05). The excellent and good rate of Neer score of shoulder joint function was 75.9% (88/116). The scores of SF-12pcs (42.9±5.2), SF-12MCS (47.5±6.0), BPI-S (4.1±1.2), BPI-I (3.6±1.1), EQ-VAS (82.3±4.4) in the excellent shoulder joint function group, The scores of SF-12PCS (30.1±3.7), SF-12MCS (33.1±3.5), BPI-S (6.3±1.2), BPI-I (6.2±1.3), EQ-VAS (72.2±5.5) in the difference group, There were statistically significant differences in SF-12PCS, SF-12MCS, BPI-S, BPI-I and EQ-VAS between the two groups (P<0.05).

Conclusion

Fracture type, bone density, injury to operation time, rotator cuff injury, postoperative time to start functional rehabilitation exercise, reduction quality and other factors affect the recovery of postoperative shoulder function, and poor shoulder function also has different degrees of negative impact on the physical and mental health and quality of life of patients.

Key words: Fractures, Proximal humeral, Shoulder joint function, Quality of life, SF-12 scale, BPI scale
表1 116例肱骨近端骨折患者术后影响肩关节功能的相关风险因素比较[例（%）]
潜在危险因素 例数 按Neer肩关节功能评分分组 χ 2值 P值
功能优良组 功能可差组
性别          
  男 53 44（83.0） 9（17.0） 2.730 0.099
  女 63 44（69.8） 19（30.2）    
年龄（岁）          
  ≥65 48 33（68.7） 15（32.3） 2.262 0.133
  <65 68 55（80.8） 13（19.2）    
骨折类型（例）          
  1、2部分 70 59（84.3） 11（15.7） 6.840 0.009
  3、4部分 46 29（63.0） 17（37.0）    
骨密度          
  T>-2.5SD 78 64（82.1） 14（17.9） 4.981 0.026
  T≤-2.5SD 38 24（63.2） 14（36.8）    
受伤至手术时间（d）          
  >4 40 25（62.5） 15（37.5） 5.953 0.015
  ≤4 76 63（82.9） 13（17.1）    
肩袖损伤（例）          
  是 29 18（62.1） 11（37.9） 4.017 0.045
  否 87 70（80.5） 17（19.5）    
侧别（例）          
  右侧 55 42（76.4） 13（23.6） 0.014 0.905
  左侧 61 46（75.4） 15（23.6）    
植骨（例）          
  是 34 26（76.5） 8（23.5） 0.010 0.921
  否 82 62（75.6） 20（24.4）    
开始功能锻炼时间（d）          
  >3 39 21（53.8） 18（46.2） 15.552 0.000
  ≤3 77 67（87.0） 10（13.0）    
复位质量（例）          
  满意 84 70（83.3） 14（16.7） 9.282 0.002
  不满意 32 18（56.3） 14（43.8）    
图4~6 男性，60岁，左肱骨近端骨折。图4~5术前X线片和3D影像示左肱骨近端4部分骨折；图6术后骨折愈合X线片，Neer肩关节功能评分90分，恢复良好
表2 116例肱骨近端骨折患者术后12个月时不同肩关节功能SF-12PCS、SF-12MCS、BIP-S、BPI-I、EQ-VAS评分的比较（分，±s）
评价指标 肩关节功能 t值 P值
优良组 可差组
SF-12PCS 42.9±5.2 30.1±3.7 12.052 <0.05
SF-12MCS 47.5±6.0 33.1±3.5 12.028 <0.05
BPI-S 4.1±1.2 6.3±1.2 -8.261 <0.05
BPI-I 3.6±1.1 6.2±1.3 -9.938 <0.05
EQ-VAS 82.3±4.4 72.2±5.5 9.849 <0.05
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