微创小切口下缝线桥术治疗肱骨大结节骨折的效果分析  

Effect analysis of suture bridge with minimally invasive incision in the treatment of humeral greater tuberosity fractures

作　　者：徐大伟[1] 丁晓敏 周进 费毫 成冬冬 周思怡 刘巍[1] XU Dawei;DING Xiaomin;ZHOU Jin;FEI Hao;CHENG Dongdong;ZHOU Siyi;LIU Wei(Department of Orthopaedics,Nantong First People's Hospital,Affiliated Hospital 2 of Nantong University,Jiangsu 226014)

机构地区：[1]南通市第一人民医院,南通大学第二附属医院创伤骨科,江苏226014

出　　处：《南通大学学报（医学版）》2024年第4期326-329,共4页Journal of Nantong University(Medical sciences)

基　　金：江苏省“333工程”项目(BRA2020204);江苏省六大人才高峰高层次人才项目(WSW-277);江苏省科教强卫青年医学重点人才(QNRC2016412)。

摘　　要：目的:比较经肩关节前外侧入路缝线桥技术与经三角肌胸大肌间沟入路钢板螺钉固定治疗肱骨大结节骨折的临床效果。方法:回顾性分析2019年1月—2024年1月诊治的肱骨大结节骨折40例,根据手术入路和内固定方式分为缝线桥组(n=18)和钢板组(n=22),缝线桥组予肩关节前外侧入路缝线桥技术治疗,钢板组予三角肌胸大肌间沟入路钢板螺钉固定治疗。比较两组患者切口长度、出血量、手术时间、住院时间、术后1 d疼痛视觉模拟评分(visual analogue scale,VAS评分)、肩关节功能Neer评分,并记录两组内固定的不良反应情况。结果:与钢板组相比,缝线桥组切口长度短,术中出血量、手术时间和住院时间少,术后1 d疼痛VAS评分低,术后1、3个月和末次随访肩关节功能Neer评分高,差异均有统计学意义(均P<0.05)。两组切口均为一期愈合,无神经损伤,术后半年随访X线片均提示骨折愈合良好。钢板组发生头静脉损伤3例,肩峰下撞击并发症4例。结论:运用微创小切口结合缝线桥技术治疗肱骨大结节骨折创伤小,并发症少,术后疼痛缓解和肩关节功能恢复效果佳,是一种微创和有效的治疗方法。Objective:To compare the clinical efficacy of suture bridge by anterolateral approach of shoulder joint and plate fixation by deltoide-pectoralis major approach in the treatment of humeral greater tuberosity fractures.Methods:A retrospective analysis was performed on 40 cases of humeral greater tuberosity fractures from January 2019 to January 2024.According to the surgical approach and internal fixation method,they were divided into suture bridge group(n=18)and plate group(n=22).The suture bridge group was treated with suture bridge by anterolateral approach of shoulder joint,while the plate group was treated with plate fixation by deltoide-pectoralis major approach.Incision length,blood loss,operation time,hospital stay,visual analogue scale(VAS)1 day after surgery and shoulder joint function Neer score were statistically compared between the two groups,and adverse reactions were recorded in the two groups.Results:Compared with the plate group,incision length was shorter,intraoperative blood loss,operative time and hospital stay were less,VAS at 1 day after surgery was lower,and the shoulder joint function Neer score at 1,3 months and the last follow-up was higher in the suture bridge group,with statistical significance(P<0.05).The incisions in both groups healed by first intention without nerve injury,and X-ray images of half a year postoperative follow-up showed good fracture healing.There were 3 cases of cephalic vein injury and 4 cases of subacromial impingement complications in the plate group.Conclusion:The use of minimally invasive small incision combined with suture bridge technique in the treatment of humeral greater tuberosity fractures is a minimally invasive and effective treatment with less trauma,fewer complications,better postoperative pain relief and shoulder joint function recovery.

关 键 词：肱骨大结节骨折 微创 锚钉 缝线桥 

分 类 号：R683.41[医药卫生—骨科学]