缝线固定技术在三角肌入路锁定板治疗肱骨近端骨折中的临床疗效

Clinical efficacy of suture fixation techniques in the treatment of proximal humeral fractures with locking plates via deltoid approach

目的 探讨三角肌入路锁定接骨板结合缝线固定技术治疗肱骨近端骨折的临床效果。方法 回顾性分析2016年3月—2020年7月中部战区总医院骨科收治的肱骨近端骨折患者55例。根据术中是否使用缝线固定技术分为锁定板结合缝线固定组(结合组)和锁定板固定组(锁定板组)。结合组34例,男性18例,女性16例;年龄31~77岁,平均59.8岁;摔伤22例,道路交通伤9例,高处坠落伤3例。锁定板组21例,男性11例,女性10例;年龄41~76岁,平均58.3岁;摔伤14例,道路交通伤5例,高处坠落伤2例。比较两组患者手术时间、术中出血量、骨折愈合时间,术后3个月及末次随访时Neer评分和视觉模拟评分(VAS)及术后并发症。结果 患者随访12~36个月,平均19.9个月。结合组术中出血量(81.4±17.4)mL vs.(98.6±32.8)mL、术后3个月Neer评分(82.3±4.9)分vs.(78.1±7.1)分、术后3个月VAS(2.5±0.8)分vs.(3.3±0.7)分,均优于锁定板组(P<0.05);而两组患者骨折愈合时间(12.2±1.8)周vs.(12.1±1.5)周、末次随访Neer评分(89.4±3.1)分vs.(86.3±6.1)分、末次随访VAS(0.3±0.5)分vs.(0.4±0.6)分差异均无统计学意义(P>0.05)。结合组发生并发症2例,发生率为6%;锁定板组3例,发生率为14%,两组比较差异无统计学意义(P>0.05)。结论 肱骨近端骨折的治疗中使用锁定板结合缝线固定技术能够减少出血量,利于早期功能锻炼,改善治疗效果。

Objective To investigate the clinical effect of locking plates via deltoid approach combined with suture fixation technique in the treatment of proximal humerus fractures.Methods The data of 55 patients with proximal humeral fractures in Central Theater General Hospital from Mar.2016 to Jul.2020 were retrospectively analyzed.They were divided into locking plate combined with suture fixation group(combined group,n=34)and locking plate fixation group(locking plate group,n=21)according to whether suture fixation technique was used intraoperatively.In the combined group,there were 18 males and 16 females;their age ranged from 31 to 77 years,with an average of 59.8 years;causes of injury:22 cases of falling injury,9 cases of traffic injury,3 cases of falling from height injury.In the locking plate group,there were 11 males and 10 females;their age ranged from 41 to 76 years,with an average of 58.3 years;causes of injury:14 cases of falling injury,5 cases of traffic injuries,and 2 cases of falling from height injury.The operative time,intraoperative bleeding,fracture healing time,Neer score and visual analogue scale(VAS)at 3 months postoperatively and at the last follow-up were compared between the two groups.And postoperative complications were recorded.Results Patients were followed up for 12 to 36 months with a mean of 19.9 months.Intraoperative bleeding[(81.4±17.4)mL vs.(98.6±32.8)mL],postoperative 3-month Neer score[(82.3±4.9)points vs.(78.1±7.1)points],postoperative 3-month VAS[(2.5±0.8)points vs.(3.3±0.7)points]were better in the combined group than those in the locking plate group(P<0.05).And the differences in fracture healing time[(12.2±1.8)weeks vs.(12.1±1.5)weeks],Neer score at last follow-up[(89.4±3.1)points vs.(86.3±6.1)points],VAS at the last follow-up[(0.3±0.5)points vs.(0.4±0.6)points]were not statistically significant(P>0.05).Two cases of complications occurred in the combined group,with an incidence of 6%,and three cases in the locking plate group,with an incidence of 14%,and the difference was not statistically significant between the two groups(P>0.05).Conclusion The use of locking plate combined with suture fixation in the treatment of proximal humeral fracture can reduce bleeding,facilitate early functional exercise and improve the treatment outcomes.