双排锚钉缝线桥与钢板固定治疗肱骨大结节骨折的临床疗效分析

Clinical Efficacy of Double Row Anchor Suture Bridge and Plate Fixation in the Treatment of Humerus Greater Fracture

目的比较双排锚钉缝线桥(doublerowanchorsuturebridge,DRA-SB)与钢板固定(platefixation,PF)治疗肱骨大结节(humerus greater tubercle,HGT)骨折的临床疗效。方法回顾性分析48例接受手术治疗的HGT骨折患者的临床资料,根据手术方式不同分为DRA-SB组(n=22)和PF组(n=26)。DRA-SB组采用内排联合外排锚钉的缝线桥固定,PF组采用肱骨近端锁定钢板固定。根据影像学检查和临床功能评估HGT位移、骨折愈合和并发症,应用视觉模拟评分(visual analogue scale,VAS)评估静息痛和活动痛,应用美国肩肘外科协会评分(Amecican shoulderand elbowsurgeons scale,ASES)评估肩关节功能,应用量角器测量肩关节最大活动度(range ofmotion,ROM)。结果两组患者在骨折愈合、住院和术后恢复日常生活时间上比较差异均无统计学意义(P均>0.05)。DRA-SB组患者切口长度明显短于PF组(P<0.05);DRA-SB组在缩短手术时间、减少术中出血量上均明显优于PF组(P均<0.05);DRA-SB组术后HGT位移较PF组增加(P<0.05)。两组术前肩关节静息痛VAS、活动痛VAS和肩关节功能ASES比较,差异均无统计学意义(P均>0.05);术后6个月时,两组患者肩关节静息痛VAS、活动痛VAS和肩关节功能ASES均明显优于术前(P均<0.05),但术后两组间静息痛VAS和活动痛VAS差异均无统计学意义(P均>0.05),而DRA-SB组术后肩关节功能ASES明显高于PF组(P<0.05),DRA-SB组在前屈和外展活动时,其最大ROM优于PF组(P<0.05)。结论DRA-SB和PF固定均是治疗HGT骨折的有效方法,但DRA-SB在手术时间、手术创伤和术后并发症上更具优势,同时也避免二次手术取出,临床接受度较高,是一种较为良好的手术方式。

Objective To compare the clinical efficacy of double row anchor suture bridge(DRA-SB)and plate fix-ation(PF)in the treatment of humerus greater tubercle(HGT)fracture.Methods The clinical data of 48 patients with HGT fracture who underwent surgical treatment were retrospectively analyzed,and the patients were divided into DRA-SB group(n=22)and PF group(n=26)according to the different surgical method.The DRA-SB group was fixed by su-ture bridge with internal row anchors and external row anchors,and the PF group was fixed by proximal humerus locking plate.The HGT displacement,fracture healing and complications were evaluated based on imageological examination and clinical function,the resting pain and activity pain were assessed by visual analogue scale(VAS),the shoulder function was assessed by Amecican shoulder and elbow surgeons scale(ASES),and maximum range of motion(ROM)was meas-ured by a protractor.Results There were no significant differences in bone healing time,hospitalization time and time to return to daily life after surgery between the two groups(all P>0.05).The incision length of patients in DRA-SB group was significantly shorter than that of PF group(P<0.05);DRA-SB group was superior to PF group in shortening sur-gery time and reducing intraoperative blood loss(all P<0.05);the postoperative HGT displacement increased in DRA-SB group compared to PF group(P<0.05).There was no significant difference in resting pain VAS,activity pain VAS of shoulder joint and shoulder function ASES between the two groups before surgery(all P>0.05);at 6 months after surgery,resting pain VAS,activity pain VAS of shoulder joint and shoulder function ASES in the two groups were significantly better than those before surgery(all P<0.05),there was no significant difference in resting pain VAS and active pain VAS between the two groups after surgery(all P>0.05),while the shoulder function ASES was significantly higher in DRA-SB group than in PF group(P<0.05),the maximum ROM in DRA-SB group was better than that in PF group during flexion and abduction(P<0.05).Conclusion Both DRA-SB and PF fixation are effective methods for the treatment of HGT fracture,but DRA-SB is a relatively good surgical method with high clinical acceptance because of its advantages in surgical time,surgical trauma and postoperative complications,and avoids secondary surgical removal.