关节镜缝合桥技术与微型钢板螺钉内固定治疗肱骨大结节撕脱骨折的疗效比较  

Arthroscopic double-row bridging suture versus minimally invasive locking plate system in treatment of avulsion fracture of humeral greater tuberosity

作　　者：桂琦[1] 张亚奎[1] 张星火[1] 刘亮[1] 赵峰[1] 成文浩[1] Gui Qi;Zhang Yakui;Zhang Xinghuo;Liu Liang;Zhao Feng;Cheng Wenhao(Orthopaedic Center,Beijing Luhe Hospital,Affiliated to Capital Medical University,Tongzhou,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京潞河医院骨中心,101149

出　　处：《中华创伤骨科杂志》2019年第2期109-115,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较关节镜下双排锚钉缝合桥技术与微型锁定钢板螺钉内固定治疗单纯肱骨大结节撕脱骨折的疗效。方法回顾性分析2012年1月至2016年12月首都医科大学附属北京潞河医院骨中心治疗的93例肱骨大结节骨折患者资料。38例采用关节镜下双排锚钉缝合桥技术治疗(关节镜组),55例采用微型锁定钢板螺钉内固定治疗(钢板组)。术后3、6、12个月及此后每6个月对患者进行规律随访并行X线检查,收集患者的手术时间、术前及末次随访时的肩关节活动度、美国肩肘外科协会功能评分(ASES)、疼痛视觉模拟评分(VAS)及并发症。结果关节镜组和钢板组单纯肱骨大结节撕脱骨折患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。93例患者术后平均随访时间为35.9个月(12~60个月)。关节镜组患者的手术时间[(97.0±20.1)min]长于钢板组[(67.5±19.0)min],差异有统计学意义(P<0.05)。末次随访时关节镜组患者的前屈上举(152.6°±12.9°)、外展上举(154.0°±13.5°)、90°位内旋角度(57.7°±12.2°)均优于微创钢板固定组(134.9°±17.8°、129.5°±18.6°、50.8°±12.9°),差异均有统计学意义(P<0.05)。末次随访时关节镜组和钢板组患者的ASES评分分别为(88.5±7.6)、(85.1±11.3)分,差异无统计学意义(P>0.05);VAS评分分别为(1.5±1.2)、(2.2±1.5)分,差异有统计学意义(P<0.05)。关节镜组术前、术后ASES评分改善率与钢板组比较差异无统计学意义(P>0.05)。90例患者骨折均在术后3个月内愈合,关节镜组3例患者术后6个月愈合。钢板组7例患者术后3~6个月出现肩关节僵硬,3例患者外展时出现疼痛。结论关节镜下双排锚钉缝合桥技术与微型锁定钢板螺钉内固定治疗单纯肱骨大结节撕脱骨折均能获得良好的骨折临床愈合。关节镜下双排锚钉缝合桥固定术后关节活动度较好,微型锁定钢板螺钉内固定的手术时间较短。Objective To compare arthroscopic double-row bridging suture and minimally invasive locking plate system in the treatment of simple avulsion fracture of humeral greater tuberosity. Methods A retrospective study was conducted of the 93 patients with avulsion fracture of humeral greater tuberosity who had been treated at Orthopaedic Center,Beijing Luhe Hospital from January 2012 to December 2016.Of them,38 were treated by arthroscopic double-row bridging suture (ADRB) and 55 by open reduction and internal fixation with minimally invasive locking plate system (MIPS).Regular X-ray follow-ups were carried out at 3,6 and 12 months postoperatively and every 6 months afterwards.Surgical time,range of motion (ROM) of the shoulder,American Shoulder and Elbow Surgeons (ASES) score,Visual Analogue Scale (VAS) and complications were recorded preoperatively and at the last follow-up. Results The patients of the arthroscopy and plate groups were comparable because there were no significant differences in the preoperative general data between them (P>0.05).The average follow-up time for the 93 patients was 35.9 months (from 12 to 60 months).The operation time for the arthroscopy group (97.0±20.1 min) was significantly longer than that for the plate group (67.5±19.0 min) (P<0.05).At the last follow-up,ante-flexion lift (152.6°±12.9°),abduction lift (154.0°±13.5°) and internal rotation angle at 90° (57.7°±12.2°) in the arthroscopy group were significantly better than those in the plate group (134.9°±17.8°,129.5°±18.6° and 50.8°±12.9°,respectively) (P<0.05).At the last follow-up,the ASES scores for the arthroscopy and plate groups were 88.5±7.6 and 85.1±11.3,respectively,showing no statistically significant difference (P>0.05);the VAS scores for the 2 groups were 1.5±1.2 and 2.2±1.5 respectively,showing a statistically significant difference between the 2 groups (P<0.05).There was no significant difference between the 2 groups in improvement of ASES scores (P>0.05).Ninety fractures healed after 3 months whi

关 键 词：肩关节 骨折固定术 内 关节镜检查 骨板 肱骨大结节撕脱骨折 

分 类 号：R687.3[医药卫生—骨科学]