肩关节脱位伴肱骨大结节骨折两种内固定比较

Comparison of two kinds of internal fixation for glenohumeral dislocation accompanied with humeral greater tuberosity fracture

摘要:

［目的］比较肱骨近端锁定钢板（locking proximal humeral plate, LPHP）与空心螺钉固定治疗肩关节脱位伴肱骨大结节骨折的临床效果。［方法］2016 年 1 月—2019 年 3 月本院收治的 76 例肩关节脱位伴肱骨大结节骨折患者，根据手术指征，40 例采用钢板固定，36 例采用螺钉固定。比较两组临床及影像结果。［结果］两组均顺利完成手术，无严重并发症。螺钉组手术时间、 切口总长度、术中失血量显著优于钢板组（P<0.05）。两组患者随访（18.84± 4.31）个月。与术后 3 个月相比，末次随访时两组患者 VAS 评分均显著减少（P<0.05），肩关节外展上举 ROM、Constant-Murley 评分显著增加（P<0.05）。术后 3 个月螺钉组 VAS 评分、 外展上举 ROM、Constant-Murley 评分均显著优于钢板组（P<0.05）。影像方面，螺钉组复位优秀率（61.11%）显著高于钢板组 （52.50%）（P<0.05）。两组骨折愈合时间比较差异无统计学意义（P>0.05）。［结论］两种方法对肩关节脱位伴肱骨大结节骨折均有较好疗效，空心螺钉固定治疗创伤小。

Abstract:

[Objective] To compare the clinical outcomes of locking proximal humeral plate (LPHP) versus cannulated screw (CS) fixa- tion for the treatment of glenohumeral dislocation accompanied with humeral greater tuberous fracture. [Methods] From January 2016 to March 2019, 76 patients received open reduction and internal fixation for treatment of glenohumeral dislocation accompanied with humeral greater tuberosity fracture in our hospital. According to the surgical indications, 40 patients were treated with LPHP, while the other 36 pa- tients were with CS. The clinical and imaging consequences were compared between the two groups. [Results] All patients in both groups were operated on successfully without serious complications. The CS group proved significantly superior to LPHP group in terms of opera- tive time, total incision length and intraoperative blood loss (P<0.05) . All patients in both groups were followed up for (18.84±4.31) months on an average. Compared with those 3 months after surgery, the VAS score significantly decreased (P<0.05) , while the abduction and for- ward flexion range of motion (ROM) , as well as Constant-Murley score significantly increased in both groups at the latest follow up (P< 0.05) , additionally, which in the CS group was significantly superior to the LPHP group at 3 months after the operation (P<0.05) . Radio- graphically, the excellent reduction rate in the CS group (61.11%) was significantly higher than that in the LPHP group (52.50%) (P<0.05) . However, there was no significant difference in the fracture healing time between the two groups (P>0.05) . [Conclusion] Both the methods are effective treatment for glenohumeral dislocation accompanied with humeral greater tuberosity fractures, by comparison, the cannulated screw fixation has a benefit of minimizing iatrogenic trauma.