关节镜下双排锚钉桥式缝合治疗老年陈旧性肱骨大结节撕脱骨折疗效分析

Clinical Efficacy of Arthroscopic Double Row Anchor Bridge Suture in the Treatment of Old Humeral Greater Tuberosity Avulsion Fracture in the Elderly

目的分析关节镜下双排锚钉桥式缝合治疗老年陈旧性肱骨大结节撕脱骨折的临床效果。方法选取2020年10月至2022年3月禹州市中心医院收治的82例老年陈旧性肱骨大结节撕脱骨折患者作为研究对象,根据不同手术方法将其分为锚钉组(41例)和钢板组(41例),锚钉组患者采用关节镜下双排锚钉桥式缝合治疗,钢板组患者采用锁定钢板内固定治疗,对比观察两组患者围手术期相关指标、疼痛程度、肩关节功能及不良事件发生情况。结果锚钉组患者手术时间虽明显长于钢板组(t=8.112,P<0.001),但术中出血量明显少于钢板组、住院时间明显短于钢板组(t=18.447、5.390,P均<0.001);术后6个月,锚钉组患者视觉模拟评分法(VAS)评分明显低于钢板组、美国肩肘外科医师协会(ASES)评分明显高于钢板组(t=10.361、9.403,P均<0.001),肩关节外旋、内旋、上举、后伸活动度均明显大于钢板组(t=9.085、11.585、5.487、7.783,P均<0.001)。锚钉组患者术后不良事件发生率为2.44%,明显低于钢板组患者的术后不良事件发生率17.07%(χ^(2)=4.987,P=0.026)。结论与锁定钢板内固定相比,关节镜下双排锚钉桥式缝合更能明显减轻老年陈旧性肱骨大结节撕脱骨折患者疼痛程度,有效改善肩关节功能,降低不良事件发生率,安全性较高。

Objective To analyze the clinical efficacy of arthroscopic double row anchor bridge suture for treating old humeral greater tuberosity avulsion fractures in the elderly.Methods Eighty-two elderly patients with old humeral greater tuberosity avulsion fractures admitted to Yuzhou Central Hospital from October 2020 to March 2022 were enrolled as research subjects and divided into the anchor group(n=41)and the plate group(n=41)according to the different surgical methods.Patients in the anchor group were treated with the arthroscopic double row anchor bridge suture,whereas patients in the plate group were treated with the locking plate internal fixation.Perioperative indicators,pain degree,shoulder joint function,and occurrence of adverse events were compared between the two groups.Results Although the operation time of the patients in the anchor group was significantly longer than that in the plate group(t=8.112,P<0.001),the intraopera-tive blood loss was significantly less,and the length of stay was significantly shorter in the anchor group(t=18.447 and 5.390,both P<0.001).At month six after surgery,the visual analogue scale(VAS)score of patients in the anchor group was significantly lower(t=10.361,P<0.001),and the American Shoulder and Elbow Surgeons(ASES)score was signifi-cantly higher in the anchor group compared with the plate group(t=9.403,P<0.001).The ranges of motion of shoulder external rotation,internal rotation,raising,and posterior extension were significantly greater in the anchor group(t=9.085,11.585,5.487 and 7.783,all P<0.001).The incidence of postoperative adverse reactions of patients in the anchor group was 2.44%,being much lower than 17.07%in the plate group(χ^(2)=4.987,P=0.026).Conclusion Compared with the locking plate internal fixation,the arthroscopic double row anchor bridge suture can significantly relieve patients’pain,effectively improve their shoulder joint function,reduce the incidence of adverse reactions in elderly patients with old humeral greater tuberosity avulsion fractures,and thus is safe to apply in clinical practice.