空心螺钉与缝线锚钉辅助锁定钢板加强固定治疗肱骨近端骨折的临床疗效研究

The comparative effectiveness research on the treatment of proximal humeral fractures by locking plate reinforcement with different assistants of cannulated screws and suture anchors

目的:探讨并比较空心螺钉与缝线锚钉辅助锁定钢板加强固定治疗肱骨近端骨折的临床疗效。方法:回顾性分析2018年1月至2020年1月海南西部中心医院收治的因肱骨近端骨折而接受锁定钢板治疗的121例患者病例资料,根据术中肱骨大结节辅助加强固定方式将其分为空心螺钉组(62例)和缝线锚钉组(59例)。记录并比较两组患者术前、术后3和12个月时上肢功能障碍评定量表(DASH)评分、肩关节功能评分(Constant-Murley)及Neer肩关节功能评分(Neer)评估肩关节功能变化。结果:空心螺钉组手术时间、术中出血量、住院时间及随访时间分别为(94.7±13.4)min、(230.5±39.2)ml、(9.2±1.3)d及(15.3±4.2)个月,与缝线锚钉组比较差异均无统计学意义(P>0.05)。所有患者术后肱骨近端骨折及大结节复位满意,无肩峰撞击发生。两组患者术后12个月的DASH评分显著均低于术后3个月,Constant-Murley评分、Neer评分显著高于术后3个月,差异均有统计学意义(t=12.069、11.446;15.553、14.879;16.223、18.209;P<0.05);空心螺钉组与缝线锚钉组术后3和12个月DASH评分、Constant-Murley评分、Neer评分比较,差异亦均无统计学意义(P>0.05)。结论:空心螺钉与缝线锚钉在手术治疗肱骨近端骨折过程中,均可有效辅助锁定钢板加强固定大结节,维持大结节解剖复位,促进肩关节功能恢复。

Objective:To investigate and compare the clinical effectiveness and efficacy of cannulated screws and suture anchors in assistance of locking plates reinforcement for enhancing fixation in the treatment of proximal humeral fractures.Methods:A retrospective analysis was conducted on the data of 121 patients with proximal humeral fractures who were treated by locking plates reinforcement at Hainan Western Central Hospital from January 2018 to January 2020.Based on the intraoperative method of auxiliary reinforcement for the greater tuberosity of humerus,the patients were divided into cannulated screw group(62 cases)and suture anchor group(59 cases).The Disabilities of the Arm,Shoulder and Hand(DASH)score,Constant-Murley Shoulder Score and Neer Shoulder Function(Neer)Score pre surgery,the 3rd month and 12th month after surgery were recorded and compared between the two groups,so as to assess the changes in shoulder function.Results:The time of operation,the intraoperative bleeding volume,the length of stay and the follow up time of cannulated screw group were respectively(94.7±13.4)min,(230.5±39.2)ml,(9.2±1.3)d and(15.3±4.2)months,and the differences of them between two groups were no significant(P>0.05).All patients were satisfactory for the postoperatively proximal humeral fractures and the reduction of greater tuberosity,and there was no acromial impingement.The DASH scores of two groups at the 12th month after surgery were lower than those at the 3rd month after surgery,and the Constant-Murley scores and Neer scores of two groups at the 12th month after surgery were higher than those at the 3rd month after surgery,and the differences of them were significant(t=12.069,11.446,15.553,14.879,16.223,18.209,P<0.05),respectively.There were no statistically significant differences in DASH score,Constant-Murley score and Neer score at 3rd month and 12th month after surgery between the two groups(P>0.05).Conclusion:During surgical treatment for proximal humeral fractures,both cannulated screws and suture anchors can effectively assist to lock plate for strengthening fixation of the greater tuberosity,and maintaining anatomical reduction of the greater tuberosity,and promoting recovery of the function of shoulder joint.