关节镜下双排锚钉缝线桥固定技术与切开复位钢板内固定术治疗单纯肱骨大结节骨折的疗效比较  

Arthroscopic double-row anchor suture fixation versus open reduction and internal plating in treatment of simple humeral fracture of the greater tuberosity

作　　者：卞为伟 唐晓波[1] 王健[1] 孙健[2] 刘璠[3] Bian Weiwei;Tang Xiaobo;Wang Jian;Sun Jian;Liu Fan(Department of Orthopaedics,Jianhu Hospital Affiliated of Nantong University,Yancheng 224700,Jiangsu,China;Department of Orthopaedics,The Tenth People's Hospital Affiliated to Tongji University,Shanghai 200040,China;Department of Orthopaedics,Affiliated Hospital to Nantong University,Nantong 226001,Jiangsu,China)

机构地区：[1]南通大学附属建湖医院骨科,江苏省盐城市224700 [2]同济大学附属第十人民医院骨科,上海200040 [3]南通大学附属医院骨科,226001

出　　处：《中华创伤骨科杂志》2020年第7期604-609,共6页Chinese Journal of Orthopaedic Trauma

基　　金：南通大学临床医学专项项目(2019LY038)。

摘　　要：目的:比较关节镜下双排锚钉缝线桥固定技术与切开复位钢板内固定术治疗单纯肱骨大结节撕脱性骨折的疗效。方法:回顾性分析2013年3月至2017年3月南通大学附属建湖医院骨科治疗的40例单纯肱骨大结节撕脱性骨折的患者资料。男23例,女17例;年龄25~70岁,平均53.2岁。所有患者骨折移位>5 mm、骨折块面积<3 cm×3 cm,无其他损伤(如肩袖损伤、SLAP损伤、Bankart损伤)。患者根据治疗方式不同分为2组:18例患者采用关节镜下双排锚钉缝线桥固定技术治疗(关节镜组),22例患者采用切开复位钢板内固定术治疗(切开组)。术后收集并比较两组患者末次随访时关节活动度、疼痛视觉模拟评分(VAS)及美国肩肘外科医师(ASES)评分。结果:关节镜组和切开组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。术后关节镜组和切开组患者术后分别获平均19、20个月随访。所有患者在术后3个月内均获骨性愈合。末次随访时关节镜组和切开组患者肩关节前屈活动度分别为152.7°±13.3°、137.7°±19.2°,外展活动度分别为146.0°±16.4°、132.4°±20.5°,VAS评分分别为(0.8±0.4)、(1.3±0.6)分,ASES评分分别为(91.8±4.1)、(87.4±5.8)分,以上项目两组间比较差异均有统计学意义(P<0.05)。切开组有2例患者发生肩峰下撞击综合征,待骨折愈合取出钢板后症状缓解;1例肩关节僵硬,麻醉下进行手法松解后好转。结论:相对于切开复位钢板内固定术,关节镜下双排锚钉固定治疗单纯性肱骨大结节撕脱性骨折具有创伤小、恢复快、术后肩关节功能恢复更好等优势。Objective To compare clinical outcomes of arthroscopic double-row anchor suture bridge fixation versus open reduction and internal plating in the treatment of simple humeral fracture of the greater tuberosity.Methods From March 2013 to March 2017 at Department of Orthopaedics,Jianhu Hospital Affiliated to Nantong University,40 patients were treated for simple humeral fracture of the greater tuberosity.They were 23 men and 17 women,aged from 25 to 70 years(mean,53.2 years).All the fracture displacements were larger than 5 mm and the fracture blocks smaller than 3 cm×3 cm.They were complicated with no other injuries like rotator cuff tear,superior labrum anterior posterior(SLAP)injury or Bankart injury.Of them,18 were treated by arthroscopic double-row anchor suture bridge fixation and 22 by open reduction and internal plating.The 2 groups were compared postoperatively in terms of joint activity,visual analogue scale(VAS)pain score,American Shoulder and Elbow Surgeon(ASES)score at the last follow-up.Results There were no significant differences in the preoperative general data between the 2 groups(P>0.05),indicating they were comparable.The arthroscopy and open reduction groups were followed up for an average of 19 and 20 months,respectively.All the patients obtained bony union within 3 months after surgery.At the last follow-up for the arthroscopy and open reduction groups,respectively,the shoulder flexion was 152.7°±13.3°and 137.7°±19.2°,the abduction 146.0°±16.4°and 132.4°±20.5°,the VAS score 0.8±0.4 and 1.3±0.6 and the ASES score 91.8±4.1 and 87.4±5.8,showing significant differences in the above items between the 2 groups(P<0.05).In the open reduction group,2 patients developed subacromial impingement syndrome which was relieved after removal of the plate following fracture union.Shoulder stiffness was observed in one case but improved after manipulative release under anesthesia.Conclusion In the treatment of simple humeral fracture of the greater tuberosity,arthroscopic double-row anchor sutur

关 键 词：肩关节 肩骨折 骨折固定 内 关节镜 

分 类 号：R687.4[医药卫生—骨科学]