两种锚钉缝线桥固定肱骨大结节骨折比较

Two anchor suture bridge fixations for internal fixation of humeral greater trochanteric fractures

摘要:

[目的] 比较单排锚钉联合骨隧道和双排锚钉技术缝线桥固定肱骨大结节骨折中的临床疗效。[方法] 回顾性分析 2017 年 6 月—2021 年 6 月收治的 44 例肱骨大结节骨折患者的临床资料。根据医患沟通结果，24 例采用单排-骨道固定，20 例采用双排锚钉。比较两组患者围手术期、随访和影像资料。[结果]所有患者均顺利完成手术，术中无神经、血管损伤等并发症发生。两组患者手术时间、术中出血量、透视次数、主动活动时间、切口愈合时间、住院时间的差异无统计学意义 （P＞ 0.05），但是，单排-骨道组切口长度显著大于双排锚钉组（P＜0.05），单排-骨道组住院总费用显著少于双排锚钉组（P＜0.05）。 与术前相比，术后 7、14 d 两组 VAS 评分显著减少 （P＜0.05），相应时间点，两组间 VAS 评分的差异均无统计学意义 （P＞ 0.05）。所有患者获随访（18.1±3.9）个月，两组患者恢复完全负重活动时间的差异无统计学意义（P＞0.05）。随着时间推移，两组患者的 ASES 评分、前屈上举 ROM、外展上举 ROM 和体侧外旋 ROM 均显著增加（P＜0.05）。相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，相应时间点，两组间骨折块移位、AHI 的差异均无统计学意义（P＞0.05）。两组骨折愈合时间的差异无统计学意义（P＞0.05）。[结论]单排锚钉联合骨隧道与双排锚钉固定均可有效治疗肱骨大结节骨折，相比之下，单排锚钉联合骨隧道显著降低了医疗费用。

Abstract:

[Objective] To compare the clinical outcomes of suture bridge fixation with single row anchors combined with bone tunnel (SR-BT) versus double rows of anchors (DR) for humeral greater trochanteric fractures. [Methods] A retrospective study was performed on 44 patients who received surgical treatment for humeral greater trochanteric fractures in our hospital from June 2017 to June 2021. Accord- ing to doctor-patient communication, 24 patients were treated with SR-BT, while the remaining 20 patients were with DR. The periopera- tive period, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had the operation ac- cordingly performed successfully with no complications such as neurovascular injury. Although there were no significant differences in terms of operation time, intraoperative blood loss, fluoroscopy times, active activity time, incision healing time and hospital stay between the two groups (P＞0.05), the SR-BT group had significantly longer incision, whereas significantly lower total hospital expenses than the DR group (P＜0.05). Compared with that preoperatively, the VAS score for pain in both groups significantly decreased 7 and 14 days after sur- gery (P＜0.05), which was not statistically significant between the two groups at any time points accordingly (P＞0.05). All patients were fol- lowed up for (18.1±3.9) months, without a significant difference in the time to return to full weight- bearing activities between the two groups (P＞0.05). The ASES score, forward flexion, abduction and external-internal rotation range of motion (ROM) significantly increased in both groups over time (P＜0.05), whereas which proved not significantly different between the two groups at any corresponding time points (P＜0.05). Radiographically, there were no significant differences in fracture block displacement and acromiohumeral interval (AHI) be- tween the two groups at any time points accordingly (P＞0.05). In addition, there was no significant difference in fracture healing time be- tween the two groups (P＞0.05). [Conclusion] Both single-row anchors combined with bone tunnel and double-row anchors are effective for internal fixation of humeral greater trochanteric fractures. By contrast, the single-row anchors combined with bone tunnel take benefit of re- ducing medical cost considerably over the double-row anchors.