锁定钢板内固定联合肩袖张力带内固定治疗肱骨近端骨折效果观察

Observation of the effect of locking steel plate internal fixation combined with rotator cuff tension band internal fixation in the treatment of proximal humeral fracture

目的:探讨锁定钢板内固定联合肩袖张力带内固定治疗肱骨近端骨折的效果。方法:收集2016年3月—2017年3月进行内固定手术治疗的60例肱骨近端骨折患者,分为对照组和观察组各30例。对照组接受锁定钢板内固定治疗,观察组接受锁定钢板内固定联合肩袖张力带内固定治疗。比较两组手术和骨折愈合情况、术后ConstantMurley肩关节功能评分和臂、肩、手功能障碍(DASH)评分变化、早期和远期并发症情况。结果:两组手术时间、术中出血量及骨折愈合时间差异无统计学意义(P>0.05)。观察组患者术后3、12和24个月的Constant-Murley评分均高于对照组,DASH评分均低于对照组,组间差异有统计学意义(P<0.05)。两组术后腋神经麻痹、三角肌乏力、并发症发生率差异无统计学意义(P>0.05)。观察组肱骨大结节复位丢失、肩峰撞击、内固定松动、外翻畸形等并发症发生率低于对照组(P<0.05)。结论:锁定钢板内固定联合肩袖张力带内固定治疗肱骨近端骨折疗效优于单纯锁定钢板内固定,且会明显降低远期并发症风险,值得临床推荐。

Objective:To investigate the effect of locking steel plate internal fixation combined with rotator cuff tension band internal fixation in the treatment of proximal humeral fractures.Methods:A total of 60 patients with proximal humeral fractures treated by internal fixation from March 2016 to March 2017 were collected and divided into a control group and an observation group with 30 cases in each group.The patients in the control group were treated with locking steel plate internal fixation and the patients in the observation group were treated with locking steel plate internal fixation combined with rotator cuff tension band internal fixation.The operation condition,fracture healing,Constant-Murley shoulder joint function score,disabilities of the arm,shoulder and hand(DASH)score,and early and long-term complications were compared between the two groups.Results:There was no significant difference in operation time,intraoperative bleeding volume and fracture healing time between the two groups(P>0.05).Constant-Murley scores in the observation group were higher than those in the control group at 3,12 and 24 months after operation,and DASH scores in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of axillary paralysis,deltoid weakness and complications between the two groups(P>0.05).The incidence of complications such as loss of reduction of greater tubercle of humerus,acromial impingement,loosening of internal fixation and valgus deformity in the observation group was lower than that in the control group(P<0.05).Conclusion:Locking steel plate internal fixation combined with rotator cuff tension band internal fixation is superior to locking steel plate internal fixation alone in the treatment of proximal humeral fractures,and can significantly reduce the risk of long-term complications,which is worthy of clinical recommendation.