经三角肌小切口双排缝合锚钉与肱骨近端解剖钢板治疗肱骨大结节撕脱性骨折疗效的对比研究  

A clinical analysis of small incision through the deltoid muscle with double-row suture anchor fixtion versus proximal humerus anatomical plate for the treatment of avulsion fracture

作　　者：王尧 曹烈虎 陈晓 潘思华 崔进 姜昊 王亚军 周启荣 陈辉文 苏佳灿 WANG Yao;CAO Lie-hu;CHEN Xiao;PAN Si-hua;CUI Jin;JIANG Hao;WANG Ya-jun;ZHOU Qi-rong;CHEN Hui-wen;SU Jia-can(Department of Orthopaedics Trauma,Changhai Hospital,Second Militaiy Medical University,Shanghai,200433,China)

机构地区：[1]海军军医大学附属长海医院创伤骨科,上海200433

出　　处：《中国骨与关节杂志》2019年第3期165-170,共6页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金重大研究计划重点支持项目(91749204);国家重点研发计划(2018YFC2001500);上海市卫计委优秀学科带头人计划(2017BR011);上海科委重点项目(15411950600)

摘　　要：目的对比经三角肌小切口双排缝合锚钉与肱骨近端解剖钢板治疗肱骨大结节撕脱性骨折的临床效果。方法对我院2014年1月至2017年1月收治的51例肱骨大结节撕脱性骨折患者的临床资料进行回顾性分析,按照治疗方法分为双排锚钉组(23例),肱骨近端解剖钢板组(28例)。比较两组的手术时间、术中出血量、术后肩关节活动度、术后Constant肩关节功能评分、美国肩肘外科协会(American shoulder andelbow surgeons,ASES)评分及视觉模拟评分(visual analogue scale,VAS),记录两组术后并发症的发生情况。结果两组术后3个月均骨性愈合。两组在年龄、性别、受伤机制、受伤至手术时间等方面相比,差异无统计学意义(P=0.632,P=0.964,P=0.795,P=0.127)。双排锚钉组的术中出血量少于解剖钢板组(50.7±20.6) ml,(100.9±30.1) ml,两组相比差异有统计学意义(P=0.000),但两组的手术时间相比,差异无统计学意义(P=0.418);术后双排锚钉组的肩关节活动度(外展P=0.006,前屈P=0.002,外旋P=0.485,内旋P=0.624)、VAS评分(P=0.000)、Constant评分(P=0.002)及ASES评分(P=0.003)高于解剖钢板组,且术后并发症发生率较低。结论经三角肌小切口双排锚钉治疗肱骨大结节撕脱性骨折创伤小,术后功能恢复良好且术后并发症少,值得临床推广。Objective To compare the differences in the operation time,postoperative shoulder mobility,functional scores and postoperative complications between the small incision double-row suture anchor and the proximal humerus anatomical plate.Methods From January 2014 to January 2017,a retrospective analysis of51 patients with avulsion fracture of the humeral greater tuberosity admitted to our hospital was performed.According to the treatment method,all patients were divided into the double-row anchor group(n=23)and the proximal humerus anatomical plate group(n=28).The operation time,intraoperative blood loss,postoperative shoulder mobility,postoperative Constant Shoulder function score,the American Shoulder and Elbow Surgeons(ASES)score,and visual analogue scale(VAS)were compared between the 2 groups,and the incidence of postoperative complications in both groups was recorded.Results All patients got bone healing within 3 months after surgery.There were no significant differences in age(P=0.632),gender distribution(P=0.964),injury mechanism(P=0.795),and injury to surgery time(P=0.127)between the 2 groups.Blood loss in the double-row anchor group(50.7±20.6)ml was significantly less than the anatomical plate group(100.9±30.1)ml(P=0.000),but there were no significant differences in the operation time between the 2 groups(P=0.418);Shoulder joint mobility,VAS score(P=0.000),Constant score(P=0.002)and ASES scores(P=0.003)in the double-row anchor group were better than the anatomical plate group,and less postoperative complications occurred.Conclusions Treatment of avulsion fracture of the humerus greater tuberosity with small incision double-row anchor nail fixation is less invasive with good postoperative function recovery and less postoperative complications.It is a surgical procedure worthy of clinical promotion.

关 键 词：肩骨折 骨折固定术 骨折切开复位 治疗结果 

分 类 号：R683.4[医药卫生—骨科学]