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目的：研究锁定钢板固定术后内侧柱的支撑能力与肱骨近端骨折患者预后的相关关系。方法：选取107例肱骨近端骨折患者作为研究对象，根据不同内侧柱支撑重建方式将所有患者分为四组，其中A组患者48例，均接受肱骨近端内侧骨皮质解剖复位以重建内侧柱支持；B 组患者20 例，均使用1 枚支撑螺钉置入肱骨头内下方的软骨下骨；C 组患者14例，均使用2 枚或2 枚以上支撑螺钉置入肱骨头内下方的软骨下骨；D组患者25 例，均未进行肱骨近端内侧骨皮质解剖复位，亦未使用锁定螺钉固定。比较各组患者术后Constant 评分、VAS（visual analogue scale）评分、骨折愈合时间、肱骨头高度丢失值、肱骨头内翻角、并发症发生情况及二次手术率。结果：与无支撑重建组相比，骨皮质解剖复位组、单枚螺钉支撑重建组以及多枚螺钉支撑重建组的VAS 评分、骨折愈合时间、肱骨头高度丢失值以及肱骨头内翻角均明显降低，而Constant评分明显升高，其中骨皮质解剖复位组的变化幅度最大，多枚螺钉支撑重建组次之，单枚螺钉支撑重建组变化幅度最小，差异具有统计学意义（t=23.100，22.130，7.267，68.440，47.900，均P<0.001）；与无支撑重建组相比，骨皮质解剖复位组、单枚螺钉支撑重建组以及多枚螺钉支撑重建组的术后总并发症发生率和二次手术率均明显降低，其中骨皮质解剖复位组的降低幅度最大，单枚螺钉支撑重建组次之，多枚螺钉支撑重建组降低幅度最小，差异具有统计学意义（X2=12.938，11.904，P=0.005，0.008）。结论：锁骨钢板固定术后内侧柱的支撑能力与肱骨近端异型解剖钢板患者预后相关，内侧柱支撑能力的越高，患者术后骨折愈合、肩关节恢复越佳，而并发症发生率以及二次手术率越低。

英文摘要:

Objective:To investigate the correlativity between medial column support after locking plate fixation and prognosis of patients with proximal humerus fractures.Methods:107 patients who had proximal humerus fractures and underwent locking plate fixation were divided into four groups according to the method of medial column support. 48 patients in group A received anatomic reduction of the cortical bone. 20 patients in group B received insertion of single medial support screw. 14 patients in group C received insertion of more than two medial support screws. 25 patients in group D had no anatomic reduction of the cortical bone or insertion of medial support screws. Compare the Constant score, visual analogue scale (VAS) score, bone healing time, average height loss of humerus head, loss of the head-shaft angle, complications and reoperation rates of patients between four groups.Results:Compared with group D, the VAS score, bone healing time, average height loss of humerus head and loss of the head-shaft angle of patients in group A, B and C all decreased significantly. But the Constant score in group A, B and C increased significantly. The increase of Constant score was the greatest in group A and smallest in group C. All had significant differences (t=23.100, 22.130, 7.267, 68.440, 47.900, all P<0. 001). Compared with group D, the complications and reoperation rates of patients in group A, B and C decreased significantly, and the decrease was the greatest in group A and smallest in groupB (X2=12.938, 11.904; P=0.005, 0.008).Conclusion:The medial column support after locking plate fixation is correlative with the prognosis of patients with proximal humerus fractures. Enhancing the medial column support of patients with proximal humerus fractures can promote the fracture healing and the recovery of shoulder functional, lower the complications and reoperation rates.

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