微型锁定钢板与空心螺钉治疗MutchⅡ型肱骨大结节骨折的疗效对比研究

Comparison of mini-locking plate and cannulated screw in the treatment of Mutch typeⅡgreater tuberosity fracture of humerus

目的比较微型锁定钢板与空心螺钉治疗MutchⅡ型肱骨大结节骨折的疗效。方法回顾性研究2017年1月—2020年1月中国人民解放军联勤保障部队第九〇二医院骨科收治的31例MutchⅡ型肱骨大结节骨折患者,男性20例,女性11例;年龄19~61岁,平均35.4岁;摔伤17例,道路交通伤9例,高处坠落伤5例。根据内固定物不同分为微型钢板组(14例)和空心螺钉组(17例)。记录两组患者手术时间、术中出血量、切口长度及骨折愈合时间。随访时记录肩关节功能活动度(ROM)及并发症,采用Constant-Murley评分(CSS)评定疗效。结果患者均获得12~32个月(平均17.4个月)随访。两组手术时间(45.9±8.2)min vs.(44.1±8.8)min、术中出血量(58.2±8.5)mL vs.(52.7±12.1)mL、切口长度(4.4±0.5)cm vs.(4.7±0.5)cm及骨折愈合时间(9.6±1.6)周vs.(10.1±2.2)周比较差异无统计学意义(P>0.05)。微型锁定钢板组无严重并发症。空心螺钉组有1例出现内固定松动,行非手术治疗,4个月畸形愈合,功能可;2例复位丢失,再次行手术治疗,恢复较满意。两组关节活动比较(微型钢板组vs.空心螺钉组),前屈上举(156.4±13.1)°vs.(127.1±17.1)°、外展(128.2±11.7)°vs.(117.9±10.0)°、后伸(43.9±11.1)°vs.(32.1±14.5)°,微型钢板组优于空心螺钉组(P<0.05)。微型钢板组CSS高于空心螺钉组(85.7±8.9)分vs.(72.7±8.1)分,P<0.05。结论与空心螺钉相比,微型钢板治疗MutchⅡ型肱骨大结节骨折具有固定牢靠、可早期行功能锻炼、肩关节功能恢复好、术后并发症少等优点。

Objective To compare the efficacy of mini-locking plate and cannulated screw in the treatment of Mutch typeⅡgreater tuberosity fracture of humerus.Methods From Jan.2017 to Jan.2020,31 patients with Mutch type II greater tuberosity fracture of humerus in our hospital were selected for retrospective study.There were 20 males and 11 females;the age ranged from 19 to 61 years,with an average of 35.4 years;there were 17 cases of falling injury,9 cases of road traffic injury and 5 cases of high falling injury.According to different internal fixation,they were divided into two groups,mini-plate group(14 cases)and cannulated screw group(17 cases).The operation time,intraoperative blood loss,incision length and fracture healing time of the two groups were recorded.The range of motion,complications and Constant Murley score(CSS)were recorded during follow-up.Results All patients were followed up for 12-32 months(mean 17.4 months).In operation time[(45.9±8.2)minutes vs.(44.1±8.8)minutes],intraoperative blood loss[(58.2±8.5)mL vs.(52.7±12.1)mL],incision length[(4.4±0.5)cm vs.(4.7±0.5)cm]and fracture healing time[(9.6±1.6)weeks vs.(10.1±2.2)weeks],there was no statistically significant difference(P>0.05).There was no serious complication in the mini-locking plate group.But in the cannulated screw group,one case had loosening of internal fixation,which was treated conservatively and malunion was achieved after 4 months,and the function was fair;2 cases lost reduction,and were treated again with operation,and the recovery was satisfactory.The comparison of joint activity between the two groups(mini-plate group vs.cannulated screw group):forward bending upward(156.4±13.1)°vs.(127.1±17.1)°,abduction(128.2±11.7)°vs.(117.9±10.0)°,extension(43.9±11.1)°vs.(32.1±14.5)°,the difference was statistically significant(P<0.05).The CSS[(85.7±8.9)points vs.(72.7±8.1)points]in the mini-plate group was higher than that in the cannulated screw group(P<0.05).Conclusion Compared with cannulated screw,mini-plate has the advantages of reliable fixation,early functional exercise,good shoulder function recovery and few postoperative complications.