| Objective This article is to provide guidance on the operations of clinical anatomy of the neck fracture surgery and to make the actual measurements and necessary mathematical descriptions of the humeral head specimens.To compare the effect of surgical treatment for surgical neck fractures of proximal humerus by AO T-Plate,LPHP and K-wire,while analyse their advantages and disadvantages.Methods 20 humeral heads from complete anti-corrosion humerus specimens①MSCT tomography②Drive and diameter measurements from top to bottom on the actual humeral head with vernier caliper③Records on the appearance characteristics of the humeral heads④Obtain geometric model equations of humeral head articular surface by math results.Retrospectively analyzed surgically treated 46 cases of surgical neck fractures of proximal humerus that can be followed up during 2000.7 to 2006.7 in Puai Hospital,20 cases in which were treated by AO T-Plate,16 by LPHP,10 by K-wire, compared the effect of these three methods.According to the effect standard of Constant-Murley shoulder accessment,the scores in 90～100 average is excellent,80～89 good,70～79 moderate,～70 bad.Results The articular surface of the humeral head is made of top and bottom 2 semi-ellipsoid balls,among the three-axis parameters of the ellipsoid ball,the head and bottom two semi-ellipsoid balls consist of two half-axle parameters,and the other axis parameters is that the bottom ellipsoid hemisphere is greater than the top one.All these cases were followed up for 5 to 77 months with a average of 37months. In AO T-Plate group,MOT(mean operating time)were 130min,MBV(mean bleeding volume)were 120ml,MHT(mean heal time)were 14weeks,All 20 fractures healed,1 case suffered screw loosen 1 month after operation,this was treated by resetting the screw and titen the plate.1 suffered avascular necrosis of humeral head after 2 years, this was treated with a TSA(Total Shoulder Athroplasty)in 3rd year after the original operation.The rate of complication is 10%.The recovery was eventually satisfactory.We found 16 excellent,2 good,1 moderate,1 bad with an 90%good-and-excellent rate in this group.In LPHP group,MOT:100min,MBV:110ml,MHT:12weeks.all 16 fratures were healed with only 1 case suffered avasscular necrosis of the humeral head.The rate of complication is 6.3%.We found 14 excellent,1 good,1 moderate and no bad with a 93.8%excellent-and-good rate in this group.In K-wire group,MOT:90min,MBV:70ml,MHT:10weeks.All I0 fractures were healed with 2 cases suffered wire shifting,1 suffered delayed union,2 suffered poor shoulder function.The rate of Complication is 50%.We found 4 execellent,1 good,4 moderate and 1 bad with a 50%excellent-and-good rate in this group.After statistical F and Chi-Square Test,there was significant difference in rate of excellent-and-good among the three groups and one to each other(P＜0.05).The distant incidence of postoperative complications among the three groups and one to each other have significant difference too(P＜0.05).No difference were found by operating time(p＞0.05).Bleeding volume and union time still have statistical significancy.(P＜0.05)Conclusion 1.The articular surface of the humeral head is a semi-ellipsoid ball, length of which from top to bottom is longer than that from front to back,and the top part is rounder while the bottom one is sharper.The result provides the anatomical base on diaplasis of fracture of three or four part of anatomical neck of humerus.2.According to the results,we concluded that LPHP&AO T plate displayed advantages of tough fixation,less complication than K-wire,much more possibility of early functional exercise,leading to better function of the shoulder joint. 3.K-wire displayed the advantages of less surgery trauma and shorter union time,is suitable for the moderate fractured patient with slightly replacement of the fractures. |
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