单排锚钉联合骨隧道与双排锚钉治疗肱骨大结节骨折的临床研究

A clinical analysis of single row anchor combined with bone tunnel and double row anchor in the treatment of humerus greater tuberosity fracture

目的探讨单排锚钉联合骨隧道(SRA-BT)与双排锚钉(DRA)治疗肱骨大结节骨折(GTF)的临床疗效。方法回顾性分析40例接受锚钉固定技术治疗的GTF患者的临床资料,根据医患沟通结果和锚钉固定方式分为SRA-BT组(18例)和DRA组(22例),SRA-BT组采用内排锚钉联合骨隧道的缝线桥固定技术,DRA组采用内排锚钉联合外排锚钉的缝线桥固定技术。比较2组患者围手术期和术后相关指标、并发症、术后肱骨大结节位移距离;术后6个月时评估患者的肩关节疼痛程度、功能和活动度。结果患者均获得骨性愈合,未发生感染和内固定失败。2组患者手术时间、术中出血量、住院时间、骨折愈合时间、术后肱骨大结节位移距离和术后恢复日常生活时间差异均无统计学意义(P>0.05)。SRA-BT组切口长度较DRA组增大,住院总费用低于DRA组(P<0.05)。2组患者术后并发症发生情况间差异无统计学意义(P>0.05)。2组患者术后静息和活动时的疼痛视觉模拟评分和美国肩肘外科协会评分(ASES)均较术前明显改善(P<0.05),而术后2组间术后静息和活动时的疼痛视觉模拟评分、ASES评分及前屈、外展、0°外旋和90°内旋的活动度比较差异均无统计学意义(P>0.05)。结论SRA-BT与DRA治疗GTF的临床疗效明确,均能有效提高肩关节功能并缓解术后疼痛,但SRA-BT在降低医疗费用上更具优势。

Objective To investigate the clinical effect of single row anchor(SRA)combined with bone tunnel(SRABT)and double row anchor(DRA)in the treatment of greater tuberosity fracture(GTF)of humerus.Methods The medical records of 40 patients with GTF treated with anchor fixation technique were retrospectively analyzed.Patients were divided into the SRA-BT group(18 cases)and the DRA group(22 cases)by surgical methods after doctor-patient communication.The suture bridge technique of SRA combined with bone tunnel was used in the SRA-BT group,and DRA with suture bridge was used in the DRA group.The perioperative and postoperative indicators,complications and postoperative displacement distance of the greater tuberosity were compared between the two groups.The pain degree,functional status and range of motion were assessed 6 months after surgery.Results Bone healing was achieved in all patients without infection or internal fixation failure.There were no significant differences in operative time,intraoperative blood loss,hospital stay,postoperative complications,bone healing time and postoperative displacement distance of the greater tuberosity between the two groups(P>0.05).The incision length was larger in the SRA-BT group than that of the DRA group(P<0.05).The inpatients costs was significantly lower in the SRA-BT group than that of the DRA group(P<0.05).There were no significant differences in postoperative complications between the two groups(P>0.05).The VAS score and ASES score at rest and activity were significantly improved after operation in both groups(P<0.05),but there were no significant differences in VAS score,ASES score and ranges of motion in flexion,abduction,0°external rotation and 90°internal rotation at rest and activity after operation between the two groups(P>0.05).Conclusion The clinical effect of technology of SRA-BT and DRA have clear clinical efficacy in the treatment of GTF,and both of them could effectively improve shoulder joint function and relieve postoperative pain.However,the SRA-BT has more advantages in reducing medical costs.