锁定钢板与空心螺钉治疗肱骨大结节骨折的疗效比较

Comparison of Curative Effect between Locking Plate and Cannulated Screw for the Treatment of Humeral Greater Tuberosity Fracture

目的：比较锁定钢板与空心螺钉治疗肱骨大结节骨折的临床疗效及安全性。方法：对2010年1月至2013年1月手术治疗的8l例单纯肱骨大结节骨折患者进行回顾性分析，患者均行切开复位内固定，固定方式分别采用锁定钢板与空心螺钉。围手术期观察指标为：手术时间、术中出血量、住院天数等。术后按时间节点随访，至少为术后1年，最终随访时给予X线摄片以观察愈合情况，采用ASES评分、Constant—Murley评分及VAS评分评估肩关节功能及疼痛程度。结果：63例患者获得随访，随访时间1-3年，平均1．9年。钢板组（33例）ASES评分（91．01±4．88）分、Constant—Murley评分（90．21：1：3．97）分、VAS评分（0．58±0．63）分，满意率为93．94％；螺钉组（30例）ASES评分（80．58±6．72）分、Constant—Murley评分（80．67±7．25）分、VAS评分（1．08±0．68）分，满意率为73．33％，差异均有统计学意义（P〈O．05）。结论：肱骨近端锁定钢板治疗单纯肱骨大结节骨折固定可靠，安全性较高，肩关节功能恢复好。并发症发生率较低。可获得较为满意的临床效果。

Objective： To compare the clinical outcomes and safety between locking plate and cannulated screw for the treatment of humeral greater tuberosity fracture. Methods： 81 cases of patients with isolated humeral greater tuberosity fracture from January 2010 to January 2013 were reviewed retrospectively. All of patients were treated by open reduction and fixation with locking plate（LPHP group） or cannulated screws （screw group）. Perioperative conditions such as operation time, hospitalization days, intraoperative blood loss were recorded. Postoperative follow-up were carried out according to the time point, follow-up duration was at least one year. X-ray was carried out for observing fracture healing at final follow-up. The visual analogue scale （VAS） for pain, American shoulder and elbow surgeon （ASES） score and Constant-Murley scoring system for shoulder function evaluation were recorded. Results： 63 eligible patients could be followed up. Duration of follow-up was 1 to 3 years, the mean follow-up time was 1.9 years. In the LPHP group （33 patients）, ASES scores averaged 91.01, Constant-Murley scores averaged 90.21, VAS scores was （P25-P75, 0-1.00）, the satisfaction rate of the LPHP goup was 93.94%; in the screw group （30 patients）, ASES scores averaged 80.58, Constant-Murley scores averaged 80.67, VAS scores was （P25-P75, 0.5-1.63）, the satisfaction rate of the screw group was 73.33%. Differences between two groups were statistically significant （P〈0.05）. Conclusions： Compared with cannulated screw fixation, treatment for isolated greater tuberosity fracture with LPHP has the advantage of more stable fixation, higher security, better shoulder function and lower incidence of complications, therefore can obtain satisfactory clinical results.