改良跟骨接骨板系统联合缝线锚钉治疗Liu-GangⅣ型肱骨大结节劈裂骨折  

Modified calcaneal plate combined with suture anchors in treatment of comminuted fracture of split-type greater tuberosity of humerus(Liu-Gang type IV)

作　　者：刘刚 张宝露 李锐辰 侯晓梅 罗鸿 赖灿豪 李青缘 梁霞 暴丁溯 扶世杰 曾胜强 Liu Gang;Zhang Baolu;Li Ruichen;Hou Xiaomei;Luo Hong;Lai Canhao;Li Qingyuan;Liang Xia;Bao Dingsu;Fu Shijie;Zeng Shengqiang(Department of Orthopedics,Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University,Luzhou 646000,Sichuan Province,China;Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center,Luzhou 646000,Sichuan Province,China;College of Nursing Affiliated to Southwest Medical University,Luzhou 646000,Sichuan Province,China;Jiangan County Hospital of Traditional Chinese Medicine,Yibin 644200,Sichuan Province,China;Clinical Medicine School of Chengdu University of TCM,Chengdu 610000,Sichuan Province,China;Department of Radiology,Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University,Luzhou 646000,Sichuan Province,China)

机构地区：[1]西南医科大学附属中医医院骨关节·足踝外科,四川省泸州市646000 [2]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,四川省泸州市646000 [3]西南医科大学护理学院,四川省泸州市646000 [4]江安县中医医院,四川省宜宾市644200 [5]成都中医药大学临床医学院,四川省成都市610000 [6]西南医科大学附属中医医院影像科,四川省泸州市646000

出　　处：《中国组织工程研究》2024年第24期3855-3861,共7页Chinese Journal of Tissue Engineering Research

基　　金：2022年度西南医科大学校级科研项目(2022QN048),项目负责人:刘刚。

摘　　要：背景:既往有许多学者研究单独的肱骨大结节骨折及其手术方式。但是,对于肱骨大结节劈裂骨折(Liu-GangⅣ型)合并肩袖损伤,几乎没有学者进行深入的细化研究。目的:比较切开复位改良的跟骨接骨板系统联合缝线锚钉和PHILOS锁定内固定系统联合强生2#号线治疗肱骨大结节劈裂骨折合并肩袖损伤(Liu-GangⅣ型)的临床疗效。方法:回顾性分析2012年5月至2022年5月30例肱骨大结节劈裂骨折合并肩袖损伤患者(Liu-GangⅣ型)的病历资料,分为改良的跟骨接骨板系统联合缝线锚钉组(A组)和PHILOS锁定内固定系统联合强生2#号线组(B组),每组15例。记录所有患者术中出血量、手术时间和切口长度,术后末次随访(>1年),评估其疼痛目测类比评分、Constant-Murley评分以及肩关节外展、前屈、外旋和背伸活动。结果与结论:①A组手术切口长度、手术时间和出血量均小于B组(P<0.05);②两组目测类比评分和Constant-Murley评分相比差异无显著性意义(P>0.05);③术后末次随访A组患者前屈功能优于B组(P<0.05);A组外展功能、外旋、背伸与B组相比差异无显著性意义(P>0.05);④并发症方面,A组1例肩关节疼痛不适(7%);B组2例肩峰下撞击综合征,2例大结节上移,2例肩关节疼痛(40%),两组并发症发生率相比差异有显著性意义(P=0.031);⑤提示采用改良的跟骨接骨板系统联合缝线锚钉治疗肱骨大结节劈裂骨折(Liu-GangⅣ型),不仅可以更好地恢复肩关节前屈功能,而且手术切口较小、出血量较少、手术时间较短,且并发症较少。BACKGROUND:Numerous scholars have previously researched certain greater tuberosity fractures and the procedures used to treat them.Few researchers,however,have studied the comminuted split fracture of the greater tuberosity of the humerus(Liu-Gang type IV)with rotator cuff tear in great detail.OBJECTIVE:To compare the clinical therapeutic effect of open repair position modified calcaneal plate combined with suture anchors and proximal humeral internal locking system(PHILOS)plate in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV).METHODS:Case data of 30 patients with comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV)from May 2012 to May 2022 were retrospectively analyzed.They were divided into the modified calcaneal plate combined with suture anchor group(group A)and the PHILOS with#2 Johnson group(group B),with 15 cases in each group.Intraoperative blood loss,surgical time,and incision length of all patients were recorded.Pain visual analog scale score,Constant-Murley score,as well as shoulder joint abduction,forward flexion,external rotation,and dorsal expansion activities during the last follow-up(>1 year)were evaluated.RESULTS AND CONCLUSION:(1)The surgical incision length and operation time were shorter,and blood loss was less in group A than those in group B(P<0.05).(2)No significant difference in visual analog scale score and Constant-Murley score was detected between the two groups(P>0.05).(3)During the last follow-up,forward flexion in group A was better than that in group B(P<0.05).No significant difference in abduction,external rotation,and dorsal expansion was determined between group A and group B(P>0.05).(4)In terms of complications,there was 1 case of shoulder joint pain and discomfort in group A(7%),2 cases of subacromial impingement syndrome,2 cases of upward movement of nodules,and 2 cases of shoulder joint pain(40%)in group B.There were significant d

关 键 词：肱骨大结节劈裂骨折 Liu-GangⅣ型 新分型 手术治疗 改良的跟骨接骨板系统 PHILOS接骨板系统 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683