三种内固定方式治疗肱骨大结节劈裂骨折的疗效比较  

A comparative study of three internal fixation techniques for split fractures of humeral greater tuberosity

作　　者：刘刚 罗鸿 张宝露 唐伟力 刘洋 覃波 邓凯 曾胜强 暴丁溯 扶世杰 Liu Gang;Luo Hong;Zhang Baolu;Tang Weili;Liu Yang;Qin Bo;Deng Kai;Zeng Shengqiang;Bao Dingsu;Fu Shijie(Department of Joint Surgery,Hospital of Traditional Chinese Medicine,Affiliated to Southwest Medical University,Luzhou 646000,China;Research Center for Orthopedic Diseases,Hospital of Traditional Chinese Medicine,Affiliated to Southwest Medical University,Luzhou 646000,China;Clinical Base in Hospital of Traditional Chinese Medicine,Affiliated to Southwest Medical University,Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology,Luzhou 646000,China;College of Nursing,Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属中医医院骨关节外科,四川泸州646000 [2]西南医科大学附属中医医院骨伤疾病研究中心,四川泸州646000 [3]广东省医学3D打印应用转化工程技术研究中心西南医科大学附属中医医院临床基地,四川泸州646000 [4]西南医科大学护理学院,四川泸州646000

出　　处：《中华创伤骨科杂志》2023年第5期407-414,共8页Chinese Journal of Orthopaedic Trauma

基　　金：2022年度西南医科大学校级科研项目(2022QN048)。

摘　　要：目的比较关节镜下空心螺钉联合缝线锚钉、单纯空心螺钉与肱骨近端锁定钢板系统(PHILOS)治疗肱骨大结节劈裂骨折的疗效。方法回顾性分析2015年5月至2020年8月西南医科大学附属中医医院骨关节外科收治的54例肱骨大结节劈裂骨折患者资料。男17例,女37例;年龄(58.4±12.1)岁。根据治疗方式不同分为3组:A组18例(采用关节镜下空心螺钉联合缝线锚钉治疗)、B组18例(单纯采用空心螺钉治疗)、C组18例(单纯采用PHILOS钢板治疗)。记录并比较3组患者手术切口长度及末次随访时肩关节功能活动度、疼痛视觉模拟评分(VAS)、美国肩肘外科协会评分(ASES)。结果3组患者术前一般资料比较差异无统计学意义(P>0.05),具有可比性。A组手术切口最短(0.7±0.1)cm,其次B组(5.0±1.4)cm,最后C组(12.8±2.1)cm,两两比较差异均有统计学意义(P<0.05)。末次随访时肩关节前屈活动度分别为159.7°±13.4°、154.9°±16.2°、160.5°±12.9°,外展活动度分别为149.6°±11.3°、142.4°±12.0°、145.1°±10.4°,3组间比较差异无统计学意义(P>0.05);外旋活动度分别为41.1°±8.1°、38.1°±7.8°、43.7°±6.2°,B组和C组比较差异有统计学意义(P<0.05)。背伸活动度分别为T12(L5至T6)、T12(L5至T7)、T12(L3至T6),3组间比较差异无统计学意义(P>0.05)。末次随访时VAS评分和ASES评分3组间比较差异均无统计学意义(P>0.05)。A、B、C组分别有2、6、4例患者发生并发症,3组间差异有统计学意义(P<0.05)。结论关节镜下空心螺钉联合缝线锚钉、单纯空心螺钉与PHILOS治疗肱骨大结节劈裂骨折均可较好地缓解疼痛并恢复关节功能,但关节镜下空心螺钉联合缝线锚钉具有微创及并发症少的优势。Objective To compare the clinical effectiveness between arthroscopic hollow screws combined with a suture anchor,hollow screws and proximal humerus internal locking system(PHILOS)in the treatment of split-type fractures of humeral greater tuberosity.Methods A retrospective study was conducted to analyze the 54 patients with split-type fracture of humeral greater tuberosity who had been admitted to Department of Joint Surgery,Hospital of Traditional Chinese Medicine,Affiliated to Southwest Medical University from May 2015 to August 2020.There were 17 males and 37 females with an age of(58.4±12.1)years.According to different treatment methods,they were divided into 3 groups.Group A of 18 cases was treated with arthroscopic hollow screws combined with a suture anchor,group B of 18 cases with hollow screws,and group C of 18 cases with PHILOS.The length of surgical incision,and range of shoulder motion,visual analogue scale(VAS),and American Shoulder and Elbow Surgeons(ASES)score at the last follow-up were recorded and compared between the 3 groups.Results There was no statistically significant difference in the preoperative general information between the 3 groups,indicating the 3 groups were comparable(P>0.05).The surgical incision in group A[(0.7±0.1)cm]was the shortest,followed by(5.0±1.4)cm in group B,and(12.8±2.1)cm in group C,showing statistically significant differences in pairwise comparison(P<0.05).In the 3 groups at the last follow-up,respectively,the shoulder forward flexion was 159.7°±13.4°,154.9°±16.2°,and 160.5°±12.9°,and the shoulder abduction 149.6°±11.3°,142.4°±12.0°,and 145.1°±10.4°,showing no statistically significant difference among the 3 groups(P>0.05);the external rotation was 41.1°±8.1°,38.1°±7.8°and 43.7°±6.2°,showing a statistically significant difference between groups B and C(P<0.05);the dorsal extension was T12(L5 to T6),T12(L5 to T7),and T12(L3 to T6),showing no statistically significant difference among the 3 groups(P>0.05).There was no statistically signi

关 键 词：肩关节 关节镜检查 骨折固定术 内 肱骨大结节劈裂骨折 空心螺钉 肱骨近端锁定钢板系统 

分 类 号：R687.3[医药卫生—骨科学]