单纯钢板与钢板联合肩袖张力带治疗肱骨近端骨折的比较

Plate only versus plate combined with tension band on rotator cuff for proximal humeral fractures

[目的]比较单纯微创钢板固定与钢板联合肩袖张力带固定治疗肱骨近端骨折的临床效果。[方法]回顾性分析2010年5月～2015年5月本科手术治疗的47例肱骨近端骨折患者。其中,24例采用单纯微创锁定钢板内固定(单纯钢板组),23例采用钢板联合肩袖张力带内固定(钢板-肩袖固定组)。比较两组间手术时间、术中出血量等情况,以及肩关节疼痛评分(VAS)、Constant-Murley评分、UCLA评分、DASH评分、盂肱关节活动度(ROM)和肱骨颈干角。[结果]钢板-肩袖固定组的手术时间、围术期出血量均大于单纯钢板组,但差异无统计学意义(P>0.05),两组围术期VAS评分的差异无统计学意义(P>0.05)。47例患者平均随访(26.14±2.18)个月。随术后时间延长,两组的Constant-Murley评分及单纯钢板组的UCLA评分显著增加(P<0.05),而DASH评分下降,但差异无统计学意义(P>0.05)。术后不同时间点钢板-肩袖固定组的Constant-Murley评分、UCLA评分和DASH评分均优于单纯钢板组。此外,随时间延长,两组的ROM均改善,其中,钢板-肩袖固定组前屈-后伸ROM及外旋-内旋ROM有显著改善(P<0.05),钢板-肩袖固定组ROM优于单纯钢板组。随术后时间延长,两组肱骨颈干角均有丢失,但钢板-肩袖固定的颈干角丢失少于单纯钢板组。[结论]对于肱骨近端骨折采用微创钢板联合肩袖张力带固定,可改善肩关节功能恢复,降低内翻畸形及大结节复位丢失。

[Objective] To compare the clinical results of minimally invasive percutaneous osteosynthesis （MIPO） plate only versus the plate combined with tension band on rotator cuff for proximal humeral fractures. [Methods] A retrospective study was done on 47 patients who underwent surgical treatment in our department for proximal humeral fractures from May 2010 to May 2015. Of them, 24 patients had fractures fixed with MIPO plate only （the plate group）, while the remaining 23 patients received internal fixation with the plate combined with tension band on rotator cuff （ the PT group）. The two groups were compared regarding to perioperative data, such as operation time, blood loss and transfusion, additionally visual analogue scale （VAS） for pain, Constant-Murley, UCLA and DASH scores, as well as glenohumeral range of motion （ROM） and humeral headneck angle. [Results] Although the PT group was greater than the plate group in operation time and perioperative blood loss （P〉 0.05） , no statistically significant differences in perioperative VAS were noticed between them （P〉0.05）. The 47 patients were followed up for an average of （26.14±2.18） months. The Constant-Murley and UCLA scores significantly increased （P〈0.05）, whereas the DASH score decreased as time went on postoperatively in both groups （P〉0.05）, correspondingly the PT group was superior to the plate group. In addition, the glenohumeral ROMs in both groups significantly improved over time （P〈0.05）, with better ROMs in the PT group than the plate group. Despite of the fact that the humeral head-neck angle declined in both groups with the passage of time after operation, the PT group proved less head-neck angle loss than the plate group. [Conclusion] MIPO plate combined with tension band on rotator cuff for proximal humeral fractures is benefit for shoulder functional recovery and reducing varus deformity and redisplacement of great trochanter fragment.