钛缆纵向固定与常规方法固定肱骨大小结节在人工肱骨头置换术中应用的比较

Comparison of titanium cable longitudinal fixation with conventional humeral tuberosities fixation for artificial humeral head replacement

目的 比较人工肱骨头置换术中应用钛缆纵向固定与常规缝线或钢丝固定肱骨大小结节的效果,明确钛缆纵向固定的有效性。方法 纳入自2016-12—2021-07采用人工肱骨头置换术治疗的40例复杂肱骨近端骨折,19例术中采用钛缆纵向固定肱骨大小结节(钛缆组),21例术中采用常规缝线或钢丝固定肱骨大小结节(常规组)。比较两组切口长度、手术时间、术中出血量、术后并发症发生率,以及末次随访时肩关节功能Constant-Murley评分。结果 40例均获得随访,钛缆组随访时间为8~48(24.79±13.20)个月,常规组随访时间为6~52(25.76±14.65)个月。随访期间所有患者均未出现钢丝或钛缆断裂、假体松动、假体周围骨折、肩关节脱位及肱骨大小结节移位等并发症。两组切口长度、手术时间、术中出血量、术后并发症发生率比较差异无统计学意义(P>0.05)。钛缆组末次随访时肩关节功能Constant-Murley评分为25~78(55.42±12.51)分,常规组肩关节功能Constant-Murley评分为30~75(52.52±10.52)分,组间比较差异无统计学意义(P>0.05)。结论 采用人工肱骨头置换术治疗复杂肱骨近端骨折术中应用钛缆纵向固定肱骨大小结节的方法切实有效,可获得与常规缝线或钢丝固定相同的短期固定效果,而且其长期固定效果有可能优于常规缝线或钢丝固定,但是还需要延长随访时间进行观察。

Objective To compare effect of titanium cable longitudinal fixation with conventional suture or wire fixation for hu-meral tuberosities for artificial humeral head replacement,and to determine the effectiveness of titanium cable longitudinal fixa-tion.Methods A total of 40 patients with complex proximal humeral fractures treated with artificial humeral head replace-ment from December 2016 to July 2021 were included,19 patients were treated with titanium cable longitudinal fixation for hu-meral tuberosities(titanium cable group),and 21 patients were treated with conventional suture or wire fixation for humeral tu-berosities(conventional group).Incision length,operation time,intraoperative blood loss,incidence of postoperative complica-tions and Constant-Murley score of shoulder joint function at the last follow-up were compared between the two groups.Re-sults All the 40 patients were followed up for 8 to 48(24.79±13.20)months in the titanium cable group and 6 to 52(25.76±14.65)months in the conventional group.During follow-up,no complications such as wire or titanium cable fracture,prosthesis loosening,periprosthesis fracture,dislocation of shoulder joint or displacement of humeral tuberosities were found in all pa-tients.There were no significant differences in incision length,operation time,intraoperative blood loss and incidence of post-operative complications between the two groups(P>0.05).At the last follow-up,the Constant-Murley score of shoulder func-tion in the titanium cable group was 25-78(55.42±12.51),while in the conventional group was 30-75(52.52±10.52),no statis-tically significant difference between the two groups was found(P>0.05).Conclusion In the treatment of complex proximal humeral fractures,the longitudinal fixation for humeral tuberosities with titanium cable is effective and can achieve similar short-term results as conventional suture or wire fixation,and its long-term effect may be better than the conventional fixation,but this needs to be testified with a longer follow-up period.