新型加压钩板治疗肱骨大结节撕脱型骨折的临床疗效评价

Novel compression hook plate versus proximal humeral internal locking system for avulsion fracture of humeral greater tuberosity

[目的]比较新型加压钩板与PHILOS钢板治疗撕脱型肱骨大结节骨折的疗效。[方法]回顾性分析2016年2月~2017年12月本院收治并符合标准的25例撕脱型肱骨大结节骨折患者,按固定方式不同分为两组,加压钩板组12例, PHILOS钢板组13例。比较两组的切口长度、出血量、手术时间。主要采用ASES及Constant-Murley评分系统CMS评价两组患者术后疗效。[结果]两组患者均顺利手术,均无术中血管损伤。加压钩板组在切口长度、术中出血量及手术时间方面均优于PHILOS组,差异有统计学意义(P<0.05)。所有患者随访12~20个月,平均(14.39±4.98)个月。随访过程中,加压钩板组无不良事件;PHILOS组中1例出现疼痛加重,肩外展上举活动受限,影像证实大结节骨块再移位,行保守治疗后4.5个月骨折畸形愈合,功能尚可。加压钩板组ASES和ConstantMurley总评分均高于PHILOS组,差异均有统计学意义(P<0.05)。骨折愈合时间加压钩板组为(10.42±1.44)周,PHILOS组为(10.92±1.04)周,两组间差异无统计学意义(t=1.013,P=0.321)。[结论]与PHILOS钢板相比,新型加压钩板治疗撕脱型肱骨大结节骨折可以减少创伤,术后肩关节功能康复更佳。

[Objective] To compare the clinical outcomes of a novel compression hook plate with the proximal humeral internal locking system(PHILOS) plate in the treatment of avulsion fractures of humeral greater tuberosity.[Methods] A retrospective study was conducted on 25 patients who underwent open reduction and internal fixation(ORIF) for avulsion fractures of humeral greater tuberosity in our hospital from February 2016 to December 2017. In term of the implants used, 12 patients had the fractures fixed with the compression hook plate(CHP), while the remaining 13 patients with the PHILOS plate. The length of the incision, intraoperative blood loss and operation time were compared between the two groups. In addition, the American Shoulder and Elbow Surgeon(ASES) score and Constant-Murley score were uses for assessment of the clinical consequences.[Results] All the patients had surgical procedures conducted smoothly without vascular injury. The CHP group consumed significantly less operation time, associated with significantly shorter incision length and less blood loss than the PHLOS group,which were statistically significant(P<0.05). All the patients were followed up for 12-20 months with an average of(14.39±4.98) months. During the follow-up period, no adverse event happened in anyone of the CHP group, whereas re-displacement of the fracture block on images was noticed in 1 patients who got pain worsen with limited motion in the PHLOS group, which united in the displaced position with acceptable function after conservative therapy. At the latest follow up, the CHP group was marked significantly higher ASES and Constant-Murley scores than the PHILOS group(P<0.05). Regarding to radiographic assessment, no a statistically significant difference in fracture healing time was noticed between the two groups(P>0.05).[Conclusion] This novel compression hook plate takes advantages of small incision, less trauma, less postoperative complications and better recovery of shoulder function over the proximal humeral internal locking system plate for the avulsion fractures of the humeral greater tuberosity.