空心钉联合带线锚钉内固定治疗老年骨质疏松性肱骨大结节骨折

Cannulated screw joint suture anchor internal fixation in the treatment of elderly osteoporotic fracture of the humeral greater tuberosity

目的探讨空心钉联合带线锚钉内固定治疗老年骨质疏松性肱骨大结节骨折的临床疗效。方法回顾性分析2010年8月至2014年8月,我院收治的59例老年骨质疏松性肱骨大结节骨折患者的资料,男31例,女28例;年龄60-93岁,平均76.9岁;左侧22例,右侧37例;均为闭合性骨折;单纯大结节骨折16例,同时合并肩关节脱位43例。术中采用空心钉固定联合锚钉固定骨折块,末次随访时按照Neer肩关节功能评分标准评定疗效：其中疼痛35分,功能30分,活动度25分,解剖位置10分。90-100分为优,80-89分为良,70-79分为可,〈70分为差。结果 59例均顺利完成手术,手术时间为37-67 min,平均48.3 min;术后随访6-18个月,平均13.4个月。无血管、腋神经损伤及伤口感染等并发症发生;骨折均获骨性愈合,骨折愈合时间为10-15周,平均13.6周,无内固定松动、骨折块移位发生。末次随访时按照Neer肩关节功能评分标准优46例（78%）,良9例（15%）,可4例（7%）,全组优良率93%。结论空心钉联合带线锚钉内固定治疗老年骨质疏松性肱骨大结节骨折具有创伤小、固定可靠、骨折愈合良好、患肢功能恢复快及并发症少等优点,是一种有效、可靠的方法。

Objective To discuss the effects of cannulated screws joint suture anchor internal fixation in the treatment of elderly osteoporotic fracture of the humeral greater tuberosity.Methods Fifty-nine patients with elderly osteoporotic humeral greater tuberosity fracture were admitted to our department from August 2010 to August 2014.There were 31 males and 28 females with an average age of 76.9 years（ range：60-93 years）,involving 22 in the left and 37 right.All cases were of closed fractures.Sixteen patients were of simple greater tuberosity fracture.Forty-three were of greater tuberosity fracture combined with shoulder dislocation.In surgery,cannulated screws and joint anchor screws were used to fix fracture blocks.Neer shoulder function assessment criteria（ 90-100 points,excellent;80-89 points,good;70-79 points,fair;〈70 points,poor） was conducted at the latest follow-up：pain 35 points,function 30 points,range of motion（ ROM） 25 points,anatomical position 10 points.Results All the 59 patients were successfully operated on in a mean time of 48.3 min（ range：37-67 min）.The mean follow-up period was 13.4months（ range：6-18 months）.No neurovascular complications or wound infection occurred.All patients obtained bony union after the mean time of 13.6 weeks（ range：10-15 weeks）.No hardware failure or re-displacement of the fracture block occurred.According to Neer shoulder function assessment：excellent in 46 cases（ 78%）,good in 9 cases（ 15%）,and fair in 4 cases（ 7%）.The overall excellent and good rate was 93%.Conclusions It demonstrates satisfactory results in the treatment of the humeral greater tuberosity with cannulated screws joint suture anchors internal fixation in elderly osteoporotic fracture with small lesion,reliable fixation,good bone healing,quick recovery of the affected limb,and less complications.It is considered as a safe and effective method.