关节镜下外排张力带固定治疗肱骨大结节骨折的疗效评价  

Evaluation of curative effects of arthroscopic external tension band fixation in the treatment of greater tubercle fracture of the humerus

作　　者：韩大伟 刘慧涛 张庆国 章国银 辛汉龙 杨洋 周晓波[1] 梁军波[2] Han Dawei;Liu Huitao;Zhang Qingguo;Zhang Guoyin;Xin Hanlong;Yang Yang;Zhou Xiaobo;Liang Junbo(Department of Sports Medicine,Taizhou Hospital of Zhejiang Province,Linhai 317000,China;Department of Orthopedics,Taizhou Hospital of Zhejiang Province,Linhai 317000,China)

机构地区：[1]浙江省台州医院运动医学科,临海317000 [2]浙江省台州医院骨科,临海317000

出　　处：《中华创伤杂志》2024年第1期65-72,共8页Chinese Journal of Trauma

摘　　要：目的比较关节镜下外排张力带固定与切开复位内固定治疗肱骨大结节骨折的疗效。方法采用回顾性队列研究分析2019年9月至2022年6月浙江省台州医院收治的55例肱骨大结节骨折患者的临床资料,其中男24例,女31例;年龄26~80岁[(61.7±10.5)岁]。35例采用切开复位钢板螺钉内固定治疗(切开组),20例采用关节镜下外排锚钉张力带固定治疗(关节镜组)。比较两组手术时间;比较两组术前、术后1个月及末次随访时视觉模拟评分(VAS)、肩关节美国肩肘外科协会(ASES)评分、Constant-Murley评分、肩关节主动活动度(前屈、外展及后伸);末次随访时观察两组骨折愈合情况;比较两组术后并发症发生情况。结果患者均获随访12~29个月[(16.9±4.0)个月]。两组手术时间差异无统计学意义(P>0.05)。两组术前VAS、ASES评分、Constant-Murley评分、肩关节主动活动度差异均无统计学意义(P>0.05)。术后1个月关节镜组VAS为3(2,3)分,低于切开组的4(3,4)分(P<0.01);末次随访时两组VAS差异无统计学意义(P>0.05)。术后1个月及末次随访时关节镜组ASES评分为(70.6±4.2)分、(90.2±3.7)分,均高于切开组的(64.7±6.4)分、(87.5±4.9)分(P<0.05或0.01)。术后1个月关节镜组Constant-Murley评分为(71.8±4.3)分,与切开组的(70.9±5.3)分差异无统计学意义(P>0.05);末次随访时关节镜组Constant-Murley评分为(94.1±3.1)分,高于切开组的(89.2±4.7)分(P<0.01)。术后1个月及末次随访时关节镜组前屈[(52.7±12.3)°、(140.0±16.9)°]、外展[(57.4±8.6)°、(125.0±14.3)°]、后伸[16(15,19)°、25(20,30)°]活动度均大于切开组前屈[(42.2±5.2)°、(110.9±14.0)°]、外展[(52.8±6.0)°、(103.7±11.7)°]、后伸[10(10,20)°、16(15,25)°]活动度(P<0.05或0.01)。末次随访时两组骨折均已愈合。两组术后均未见明显切口感染、关节僵硬等并发症。切开组2例患者术后1~3个月出现内固定失效,行翻修手术;6例患者术后3~6�Objective To compare the clinical outcomes of arthroscopic external tension band fixation versus open reduction and internal fixation in the treatment of greater tubercle fracture of the humerus.Methods A retrospective cohort study was conducted on 55 patients with greater tubercle fracture of the humerus admitted to Taizhou Hospital of Zhejiang Province from September 2019 to June 2022,including 24 males and 31 females,aged 26-80 years[(61.7±10.5)years].Out of them,35 patients treated with open reduction and internal fixation(open reduction group),and 20 patients were treated with external anchor tension band under arthroscopy(arthroscopy group).The operation time,and the Visual Analogue Scale(VAS)score,American Shoulder and Elbow Surgeons(ASES)score,Constant-Murley score and shoulder active range of motion(anterior flexion,abduction and posterior extension)before operation,at 1 month after operation and at the last follow-up were compared between the two groups.Bone healing was observed in both groups at the last follow-up.Postoperative complications were compared between the two groups.Results All the patients were followed up for 12-29 months[(16.9±4.0)months].There was no significant difference in operation time between the two groups(P>0.05).There were no significant differences in the VAS score,ASES score,Constant-Murley score and shoulder active range of motion between the two groups before operation(P>0.05).The VAS score of the arthroscopy group was 3(2,3)points at 1 month after operation,which was significantly lower than that of the open reduction group[4(3,4)points](P<0.01).No significant difference was found in the VAS score at the last follow-up between the two groups(P>0.05).The ASES scores of the arthroscopy group were(70.6±4.2)points and(90.2±3.7)points at 1 month after operation and at the last follow-up respectively,which were significantly higher than those of the open reduction group[(64.7±6.4)points and(87.5±4.9)points respectively](P<0.05 or 0.01).There was no significant difference i

关 键 词：肩关节 关节镜检查 缝线 肱骨大结节骨折 

分 类 号：R687.3[医药卫生—骨科学]