内侧支撑联合肩袖缝合技术治疗肱骨近端骨折的疗效观察

Clinical effect of medial support combine with rotator cuff suture for treating proximal humeral fracture

目的探讨在治疗肱骨近端骨折中肱骨距螺钉内侧支撑联合肩袖缝合技术的优势及对肩关节功能恢复的影响。方法回顾性分析2017年6月—2019年3月收治的33例肱骨近端骨折患者临床资料,均采用手术治疗,手术入路为胸大肌三角肌入路,使用肱骨近端解剖型锁定接骨板,在钢板孔中植入肱骨距螺钉内侧支撑联合肩袖缝合技术,33例患者均获得随访,分析33例患者骨折分型、年龄、手术时间、术中出血量、切口长度、住院时间、术后并发症发生率、末次随访肩关节功能。结果 33例采用肱骨距螺钉内侧支撑联合肩袖缝合技术治疗肱骨近端骨折患者:NeerⅡ型16例、NeerⅢ型13例、NeerⅣ型4例,患者平均年龄为(59.8±12.3)岁、平均手术时间(102.6±29.2)min、平均术中出血量(167.6±121.5)mL、平均切口长度(12.5±2.6)cm、平均住院时间(13.3±6.3)d、术后并发症发生率为6.1%,Constant-Murley肩关节功能评分优良率为87.9%。结论肱骨距螺钉内侧支撑联合肩袖缝合治疗肱骨近端骨折疗效显著,其优势:①能够有效复位及稳定大结节及小结节骨折块;②修复损伤肩袖、降低肩袖对肱骨头的内翻应力从而减少肱骨头螺钉切出风险;③肱骨距螺钉位于骨质密度较高区域,螺钉把持力及稳定性好,能降低肱骨头内翻及螺钉切出几率;④术后可早期进行肩关节功能锻炼且肩关节功能恢复满意。

Objective To explore the advantages of the technique of medial humeral screws and rotator cuff suture in the treatment of proximal humeral fracture and its influence on the functional recovery of shoulder joint.Methods Total 33 patients with proximal humeral fractures treated by surgery from June 2017 to March 2019 were retrospectly analyzed.All patients were treated surgically through the deltoid approach of pectoralis major muscle.The proximal humerus anatomical locking plate for internal fixation was used,and the medial support of calcar screw and the rotator cuff suture technique were implanted into the plate foramen.All patients were followed up.The fracture type,age,hospital day,operation time,incision length,operative bleeding volume,incidence of complications were analyzed.Results Thirty-three cases of proximal humeral fractures were treated with medial support of calcar screw combined with rotator cuff suture technique:16 cases of Neer typeⅡ,13 cases of Neer typeⅢand 4 cases of Neer typeⅣ.The average age of the patients was(59.8±12.3)years,the average operation time was(102.6±29.2)minutes,the average intraoperative bleeding volume was(167.6±121.5)mL,the average incision length was(12.5±2.6)cm,the average length of hospital day was(13.3±6.3)days,the incidence of complications was 6.1%,and the excellent rate of Constant-Murley shoulder function score was 87.9%.Conclusion Clinical effect of medial support combine with rotator cuff suture for treating proximal humeral fracture is effective.Advantages:①It can effectively reduce and stabilize the fracture of large and small tubercles;②It repairs the injured rotator cuff,reduces the varus stress of rotator cuff on the humeral head,thereby reducing the risk of screw cutting out;③The humeral calcar screw is located in the high bone density area,with good screw holding force and stability,which can reduce the chances of humeral head varus and screw cutting out;④Shoulder joint function exercise can be performed early after operation and the recovery of shoulder joint function is satisfactory.