锁定钢板加缝线技术与空心拉力螺钉技术固定肱骨大结节骨折效果比较

Comparison between locking plate and suture technique and hollow pull screw technique in fixation of humeral tubercle fracture

目的通过比较锁定钢板加缝线技术与空心拉力螺钉固定肱骨大结节骨折的力学稳定性,探讨优化肱骨大结节骨折的内固定方式。方法选择信阳市中医院2015年1月至2019年4月收治的肱骨大结节骨折患者52例,按照随机数字表法分为对照组22例和观察组30例,对照组采用半螺纹松质骨空心钉固定,观察组采用小型锁定钢板固定并辅助不可吸收缝合线缝合肩袖于钢板上。两组术后外固定时间、康复锻炼方式相同,术后随访半年。观察比较两组患者内固定失效率,失效后大结节骨折块上方移位距离,肩峰撞击发生率。结果观察组术后内固定失效率、肩峰下撞击发生率均明显小于对照组(P<0.05);术后6个月肩关节功能评分优良率高于对照组(P<0.05)。结论锁定钢板固定骨折块辅助不可吸收缝合线缝合肩袖于钢板上,这种手术方式骨折稳定性明显高于空心拉力螺钉固定方式,并且患者术后可以更早接受更大强度的功能锻炼。

【Objective】To compare the mechanical stability of humeral tubercle fracture with locking plate plus suture technique and hollow pull screw fixation,and to explore the optimization of internal fixation of humeral tubercle fracture.【Methods】Fifty-two patients with humeral tubercle fracture in Xinyang Traditional Chinese Medicine Hospital from January 2015 to April 2019 were divided into two groups according to random digital table method.The control group was fixed with semithreaded cancellous bone hollow nail.The observation group was fixed with small locking plate and assisted non-absorbable suture to suture rotator cuff on the plate.The external fixation time and rehabilitation exercise were the same in the two groups.The loss of internal fixation,displacement distance above the greater tuberosity fracture block after failure,incidence of acromion impact were observed and compared between the two groups.【Results】The loss of internal fixation in the observation group was significantly smaller than that in the control group,resulting in the incidence of acromion impact less than that in the control group(P<0.05).Six months after operation,the excellent and good rate of shoulder function score was higher in the observation group than in the control group(P<0.05).【Conclusion】The fracture stability of locking plate fixation fracture block is significantly higher than that of hollow screw fixation,and the patients can receive more intensive functional exercise earlier after operation.