两种固定方式治疗粉碎性肱骨大结节骨折的对比  

Double-row anchors versus locking proximal humeral plate for comminuted fracture of greater tuberosity

作　　者：帅永明[1] 曾凡辉 涂淑强[1] SH⁃UAI Yong-ming;ZENG Fan-hui;TU Shu-qiang(Hongdu Chinese Traditional Medicine Hospital,Nanchang 330000,China)

机构地区：[1]南昌市洪都中医院

出　　处：《中国矫形外科杂志》2020年第2期159-164,共6页Orthopedic Journal of China

摘　　要：[目的]比较有限切开复位双排锚钉缝合固定与解剖钢板内固定治疗粉碎性肱骨大结节骨折的临床疗效。[方法]2014年4月~2017年12月收治的38例粉碎性肱骨大结节骨折患者的资料进行回顾性分析,其中采用切开复位锚钉内固定治疗17例(锚钉组),采用切开复位解剖钢板内固定治疗21例(钢板组),比较两组在手术时间、出血量、切口长度及肩关节功能上的差异。[结果]所有患者均顺利完成手术。锚钉组手术时间、术中出血量及手术切口长度显著优于钢板组,差异有统计学意义(P<0.05)。两组患者均获得12~30个月随访,平均(17.84±4.40)个月,末次随访时两组患者在前屈上举和外旋活动度、VAS和Constant-Murley评分的差异均无统计学意义(P>0.05)。按Neer评分,锚钉组临床结果评定为优11例、良4例、可2例,优良率88.24%;钢板组临床结果评定为优12例、良5例、可3例、差1例,优良率80.95%;两组间差异无统计学意义(P>0.05)。影像评估方面,两组患者术后骨折复位质量的差异无统计学意义(P>0.05);锚钉组平均骨折愈合时间(8.29±1.61)周,而钢板组为(7.81±1.47)周,两组间差异无统计学意义(P>0.05)。末次随访时,X线片上未发现明显骨折移位、内固定失效、锚钉拔出及缝线桥断裂等。[结论]与解剖钢板内固定相比,双排锚钉缝合固定可以减少手术创伤,在严格掌握手术适应证的情况下,推荐使用双排锚钉缝合固定治疗粉碎性肱骨大结节骨折。[Objective]To compare the clinical outcomes of double-row anchors versus locking proximal humeral plate for comminuted fractures of humeral greater tuberosity.[Methods]A retrospective study was conducted on 38 patients who re⁃ceived surgical treatment for comminuted fractures of the greater tuberosity from April 2014 to December 2017.Of them,17 pa⁃tients had the fractures fixed with double-row anchors,while the other 21 patients had internal fixation with locking proximal humeral plate.The operation time,intraoperative blood loss,incision length and shoulder function evaluated by using range of motion(ROM),VAS and Constant-Murley scores,as well as radiographic examination were compared between the two groups.[Results]All patients in both groups received successfully operations.The anchor group proved significantly superior to the plate group in operation time,intraoperative blood loss and incision length(P<0.05).The patients were followed up for 12-30 months with an average of(17.84±4.40)months.At the latest follow up,no statistically significant differences were found be⁃tween the two groups regarding to ROMs of forward flexion and external rotation,VAS and Constant-Murley scores(P>0.05).Based Neer score,the clinical consequences were marked as excellent in 11,good in 4 and fair in 2 with excellent and good rate of 88.24%in the anchor group,whereas excellent in 12,good in 5 fair in 3 and poor in 1 with excellent and good rate of 80.95%in the plate group,which was not statistically significant(P>0.05).In term of radiographic assessment,no a significant differ⁃ence was noted in quality of fracture reduction between the two groups(P>0.05).The fracture healing achieved in(8.29±1.61)weeks in the anchor group,whereas(7.81±1.47)weeks in the plate group,which proved no statistical significance(P>0.05).To the latest follow up,no displacement of fracture,failure or pullout of the implants were noticed in any patient of both groups.[Conclusion]Compared with the anatomical plate,this double-row anchor technique d

关 键 词：肱骨大结节骨折 双排锚钉固定 解剖锁定钢板 内固定 

分 类 号：R683.41[医药卫生—骨科学]