单纯肱骨大结节骨折内固定术后失败原因分析及治疗策略

Analysis of postoperative failure reasons and treatment strategies for simple greater tuberosity fractures of the humerus with internal fixation

目的分析单纯肱骨大结节骨折行钢板螺钉内固定术的失败病例,总结内固定失败的原因并提出规避方法.方法回顾性分析自2019年1月至2022年6月在我院行切开复位钢板螺钉内固定治疗单纯肱骨大结节骨折患者59例,随访中内固定失效7例.记录患者的基线资料、围手术期指标;随访骨折愈合及功能恢复情况,记录相关并发症,术后1、3个月及末次随访用Neer评分、Constant-Murlery评分评估肩关节功能,视觉模拟评分(visual analogue scale,VAS)评估肩关节活动时疼痛情况.结果所有患者手术过程均顺利,平均手术时间为(65.5±17.8)min,平均出血量为(45.7±20.6)ml,平均切口长度为(6.4±3.5)cm.所有患者均获得随访,时间为12~30个月,平均(16.3±5.4)个月,随访过程中52例患者骨折愈合,平均愈合时间为(12.2±3.3)周.术后1、3个月以及末次随访Neer评分分别为(65.34±8.15)分、(75.33±9.36)分、(89.52±11.34)分;Constant-Murlery评分分别为(64.44±17.25)分、(75.62±18.44)分、(89.30±5.88)分;活动时VAS分别为(4.66±0.81)分、(2.34±1.50)分、(1.68±0.68)分.7例患者术后3个月内出现内固定失效,大结节骨块移位.3例患者行术后翻修,4例行外展架制动,随访过程中骨折均愈合.结论钢板螺钉内固定是单纯肱骨大结节骨折的有效治疗方法,钢板位置偏差、肩袖缝合欠佳、大结节骨块碎裂及术后制动不规范是内固定失效的主要原因,临床需注意规避.

Objective To analyze the failure cases of simple greater tuberosity fractures of the humerus treated with plate and screw internal fixation,summarize the reasons for internal fixation failure,and propose avoidance methods.Methods A retrospective analysis was conducted on 59 patients with simple greater tuberosity fractures of the humerus treated with open reduction and internal fixation with plates and screws in our hospital from January 2019 to June 2022.During follow-up,7 cases of internal fixation failure were observed.The patient's baseline data and perioperative indicators were recorded.The fracture healing and functional recovery were followed up.The related complications were recorded and shoulder joint function was evaluated using Neer score and Constant-Murley score at 1,3 months after surgery and the last follow-up.The pain during shoulder joint movement was evaluated using visual analogue scale(VAS).Results The surgical process was smooth for all patients,with an average surgical time of(65.5±17.8)minutes,an average bleeding volume of(45.7±20.6)ml,and an average incision length of(6.4±3.5)cm.All patients were follow-up for a period of 12 to 30 months,with an average of(16.3±5.4)months.During the follow-up process,52 patients experienced fracture healing,with an average healing time of(12.2±3.3)weeks.The Neer scores at postoperative 1,3 months,and the last follow-up were(65.34±8.15)points,(75.33±9.36)points,and(89.52±11.34)points,respectively.The Constant-Murley scores were(64.44±17.25)points,(75.62±18.44)points,and(89.30±5.88)points,respectively.The VAS during the activity were(4.66±0.81)points,(2.34±1.50)points,and(1.68±0.68)points,respectively.Seven patients experienced internal fixation failure and displacement of greater tuberosity bone blocks within three months after surgery.Three patients underwent postoperative revision,and four patients underwent external fixation.During follow-up,all fractures healed.Conclusion The internal fixation with plates and screws is an effective treatment method for simple greater tuberosity fractures of the humerus.The main causes of internal fixation failure include deviation of plate position,poor rotator cuff suture,fragmentation of tuberosity bone fragments,and improper postoperative immobilization.The clinical attention should be paid to avoiding these factors.