可吸收线缝合肩袖骨块技术辅助PHILOS钢板治疗肱骨近端粉碎性骨折的早期疗效  

Early effect of absorbable suture rotator cuff bone block technique assisted with PHILOS plate in the treatment of comminuted proximal humeral fractures

作　　者：周道斌 宁仁德 方闰 吴世桐 毕程浩 Zhou Daobin;Ning Rende;Fang Run;Wu Shitong;Bi Chenghao(Department of Joint Orthopedics,The Third Affiliated Hospital of Anhui Medical University,Hefei 230061,China)

机构地区：[1]安徽医科大学第三附属医院关节骨科,合肥230061

出　　处：《创伤外科杂志》2021年第10期728-733,共6页Journal of Traumatic Surgery

摘　　要：目的探讨可吸收线缝合肩袖骨块技术辅助肱骨近端锁定钢板(PHILOS)治疗肱骨近端粉碎性骨折的早期疗效。方法回顾性分析2016年1月—2018年12月安徽医科大学第三附属医院关节骨科手术治疗肱骨近端粉碎性骨折患者57例,按治疗方法不同分对照组(28例)和观察组(29例)。对照组行切开复位单纯PHILOS钢板内固定治疗,男性11例,女性17例;年龄54~71岁,平均62.8岁;Neer分型Ⅲ型11例,Ⅳ型17例;摔伤21例,道路交通伤7例。观察组行切开复位1-0薇乔可吸收线缝合大、小肩袖骨块辅助PHILOS钢板内固定治疗,男性13例,女性16例;年龄49~73岁,平均61.8岁;Neer分型Ⅲ型10例,Ⅳ型19例;摔伤23例,道路交通伤6例。比较两组患者一般资料、手术和愈合情况、术后Constant-Murley评分和Neer评分、肱骨颈干角(NSA)和肱骨头高度(HHH)变化情况以及术后并发症情况。结果两组患者性别、年龄、吸烟情况、致伤原因和Neer分型以及手术时间、术中出血量、临床愈合时间和完全负重时间比较,差异均无统计学意义(P>0.05);观察组术后6、12个月的Constant-Murley评分和Neer评分均高于对照组[(69.93±14.87)分vs.(51.23±15.37)分、(75.68±11.24)分vs.(61.86±13.42)分、(80.83±9.32)分vs.(71.49±8.98)分、(87.39±8.56)分vs.(81.63±6.74)分,P<0.05];观察组末次随访NSA和HHH变化平均值小于对照组。对照组术后骨块复位不良、骨块再移位、肩峰下撞击、螺钉切出发生率显著高于观察组(10.7%vs.3.4%、17.9%vs.0、7.1%vs.3.4%、10.7%vs.3.4%,P<0.05)。结论与单纯PHILOS钢板内固定治疗肱骨近端粉碎性骨折比较,可吸收线缝合肩袖骨块技术辅助PHILOS钢板内固定能更好地恢复骨块的解剖位置和抵消肩袖的内翻应力,为良好的预后提供重要基础,值得临床推广应用。Objective To investigate the early effect of absorbable suture rotator cuff bone block technology assisted with proximal humerus locking plate(PHILOS)in the treatment of comminuted proximal humeral fractures.Methods Retrospective analysis was conducted in 57 patients with comminuted proximal humeral fractures treated in Department of Joint Orthopedics,The Third Affiliated Hospital of Anhui Medical University from Jan.2016 to Dec.2018.According to the treatment method,they were divided into control group(n=28,treated with open reduction and locking plate fixation of proximal humerus)and observation group(n=29,treated with open reduction and 1-0 vicryl absorbable suture of large and small rotator cuff bone mass assisted with locking plate fixation of proximal humerus).There were 11 males and 17 females in the control group;the average age was 62.8 years(range,54-71 years);according to Neer classification,there were 11 cases of type Ⅲ and 17 cases of type Ⅳ;there were 21 cases of falling injury and 7 cases of road traffic injury.There were 13 males and 16 females in the observation group;the average age was 61.8 years(49-73 years);according to Neer classification,there were 10 cases of type Ⅲ and 19 cases of type Ⅳ;There were 23 cases of falling injury and 6 cases of road traffic injury.The general information before operation,operation and healing,Constant-Murley score and Neer score after operation,changes of humeral neck shaft angle(NSA)and humeral head height(HHH),and postoperative complications were compared between the two groups.Results There was no significant difference in gender,age,smoking,cause of injury and neer classification between the two groups(P>0.05);there was no significant difference in operation time,intraoperative blood loss,clinical healing time and complete weight-bearing time between the two groups(P>0.05);the Constant-Murley score and Neer score of the observation group at 6 and 12 months after operation were higher than those of the control group[(69.93±14.87)points vs.(51.23±1

关 键 词：肱骨近端骨折 PHILOS钢板 缝合 内固定 

分 类 号：R687.3[医药卫生—骨科学]