钩状钢板与空心螺钉治疗劈裂型肱骨大结节骨折的比较

Hook plate versus cannulated screws for split fracture of humeral greater tuberosity

[目的]比较钩状钢板与空心螺钉治疗劈裂型肱骨大结节骨折的疗效。[方法]选取2013年6月~2016年5月本院收治并符合标准的23例劈裂型肱骨大结节骨折患者进行回顾性研究,根据手术方式不同分为两组,其中10例采用钩状钢板内固定作为钩板组,13例采用空心螺钉内固定作为螺钉组。记录两组患者手术时间和术中出血量。随访时记录关节活动度(ROM)和并发症,按照Constant-Murley评分(CSS),疼痛视觉模拟评分(VAS),美国肩肘外科协会评分(ASES)标准评定疗效。[结果]两组手术时间、术中出血量差异无统计学意义(P>0.05)。所有患者均获随访1~2年,平均1.2年。钩板组无严重并发症,但螺钉组有1例出现内固定物松动,行保守治疗;有1例复位丢失,行手术治疗。两组关节活动度比较:前屈上举(156.53°vs 128.13°)、外旋(33.39°vs 16.24°)、内旋评分(9.87 vs 5.55),钩板组优于螺钉组,差异均有统计学意义(P<0.05)。在功能评分方面,CSS评分(85.25 vs70.23)和ASES评分(87.36 vs 73.89)钩板组高于螺钉组,而VAS评分(1.12 vs 3.52)钩板组低于螺钉组,差异均有统计学意义(P<0.05)。[结论]与空心螺钉内固定相比,钩状钢板内固定治疗劈裂型肱骨大结节骨折具有固定牢固、术后并发症少、肩关节功能恢复佳等优点。

[Objective] To compare the efficiency of hook plate versus cannulated screws for split fracture of humeral great- er tubemsity. [Methods] A retrospective study was done on 23 patients who received surgical treatment for split fracture of hu- meral greater tuberosity in our hospital from June 2013 to May 2016. According to internal fixation used, the patients were divid- ed into 2 groups, including 10 patients in the hook plate group and the remaining 13 patients in the screw group. The operation time, blood loss and complications were recorded. In addition, ROM, Constant Shoulder score （CSS）, Visual analogue scale （VAS）, and American Shoulder and Elbow Surgeons （ASES） Score were used for evaluation of the consequences. [Results] There was no significant differences between the two groups in operation time and intraoperative blood loss （P〉0.05） .The pa- tients were followed up for 1 to 2 years with an average of 1.2 years. In the screw group, lpatient had loosening of the internal fixation, which treated conservatively, another patient had surgical revision for loss of reduction. By contrast, no severe compli- cation happened in the plate group. Regarding to the motion, ROM proved the forward flexion of 156.53~ in the plate group ver- sus 128.13° in the screw group, external rotation of （33.39° versus 16.24°）, and internal rotation score （9.87 versus.5.55）, associ- ated with statistically significant differences between the groups （P〈0.05） . In terms of functional scores, the plate group were statistically superior to the screw group in CSS （85.25versus 70.23） and ASES （87.36 versus 73.89） （P〈0.05）, conversely, the for- mer was significantly inferior to the latter in the VAS （1.12 versus 3.52） （P〈0.05）. [Conclusion] Compared with cannulatedscrew fixation, hook plate fixation for split fracture of humeral greater tuberosity has the advantages of stronger fixation strength, less postoperative complications and better recovery of shoulder function.