解剖钢板治疗肩关节脱位合并肱骨大结节骨折疗效观察

The Clinical Observation of Anatomical Plate in the Treatment of Shoulder Dislocation Combined with Fracture of Greater Tuberosity of Humerus

目的:比较解剖钢板和保守方法治疗肩关节脱位合并肱骨大结节撕脱骨折的治疗效果。方法:选择收治的创伤性肩关节前脱位合并肱骨大结节撕脱骨折患者58例,按治疗方式分为I组与II组,I组采用保守治疗,II组采用切开复位解剖钢板固定治疗,通过视觉模拟疼痛评分,美国肩肘关节外科医师评分等比较两组的疗效。结果:两组均获为期12个月的随访,末次随访时,I组和II组病例大结节骨折的平均愈合时间分别为(3.2±0.8)个月和(3.0±0.5)个月,差异无统计学意义(P>0.05)。临床评估方面,I组和II组治疗前的平均VAS评分分别为(7.9±1.2)和(8.1±1.5);平均ASES评分分别为(13.7±9.6)和(15.1±8.6),在末次随访时,I组和II组的VAS评分分别为(1.8±1.3)和(1.5±1.3),差异均无统计学意义(P>0.05)。平均ASES评分,I组患者为(87.2±9.6)分,明显低于II组的(93.8±12.5)分,差异有统计学意义(P<0.05),II组显著优于I组。结论:在肩关节前脱位合并肱骨大结节撕脱骨折的治疗中,对于大结节撕脱骨折采用保守治疗或解剖钢板内固定治疗均可取得良好的临床效果,但解剖钢板固定治疗患者的早期功能效果更佳。

Objective：Compare the curative effect of anatomical plate and conservative methods in the treatment of patients with shoulder dislocation combined with avulsion fracture of greater tuberosity of humerus. Methods： 58 patients with shoulder dislocation combined with avulsion fracture of greater tuberosity of humerus in our hospital were selected, according to the treatment approach, they were divided into group I and group II, the patients in group I were treated with conservative therapy, while group II were treated with open reduction and anatomical plate fixation, the curative effect were evaluated by means of visual analog pain score, American Shoulder and Elbow Surgeons score. Results： Both groups were appointed for a 12 months follow-up, at the last follow-up, the av erage healing time in group I and group II were （3.2±0.8） months and （3i0.5） months, respectively, the difference were not sta tislically significant （P〉0.05）. The clinical evaluation, the average score of the VAS for group I and group II before treatment were （7.9±1.2） and （8.1±1.5）, respectively; the average score of the ASES were （13.7±9.6） and （15.1±8.6）, before the treat memt. At the last follow-up, the VAS score for group I and group II were （1.8±1.3） and （1.5±1.3）, respectively, there was no significant difference（P±0.05）. The average ASES score was （87.2 ± 9. 6）, which was significantly lower than that of group II （93.8±12.5）, the difference was statistically significant（P%0.05）. Conclusion：Both conservative treatment and anatomic plate internal fixation can achieve good clinical results in the treatment of shoulder dislocation combined with fracture of greater tuberosity of humerus, but the early functional recovery of anatomical plate fixation is better than that of Conservative treatment.