肱骨近端锁定钢板联合锚钉治疗老年肩关节脱位合并肱骨大结节骨折的疗效观察
|
摘要
目的探讨肱骨近端锁定钢板联合锚钉治疗老年肩关节脱位合并肱骨大结节骨折的临床效果。方法对2013年1月至2017年10月我院收治的30例老年肩关节脱位合并肱骨大结节骨折患者,按照值班日,由我科两个创伤骨科治疗组分别收治患者,依照手术方案将两组随机定义为观察组和对照组。所有患者肩关节复位后,复查CT提示大结节骨折块移位>5 mm。观察组使用肱骨近端锁定钢板联合锚钉复位固定肱骨大结节和修复肩袖;对照组仅使用肱骨近端锁定钢板固定肱骨大结节。术后随访评估患者肩关节活动度并进行疼痛视觉模拟评分(visual analogue scale,VAS),采用Constant-Murley肩关节评分系统评估患者术后肩关节功能恢复情况。结果本组均获12～18个月随访,两组肱骨大结节骨折平均愈合时间相比差异无统计学意义(P>0.05)。两组术后VAS评分较术前均明显下降,两组相比差异均有统计学意义(P=0.000),但两组术后VAS评分相比,差异无统计学意义(P>0.05)。两组患者术后Constant-Murley评分较术前明显升高,差异有统计学意义(P=0.200);且术后观察组Constant-Murley评分明显高于对照组,差异有统计学意义(P=0.032)。根据功能评级,观察组术后优良率达86.67%,而对照组优良率仅为66.67%。观察组术后未发生明显并发症,而对照组有5例出现肱骨大结节骨折块移位,2例出现肩峰下撞击综合征。结论肱骨近端锁定钢板联合锚钉治疗老年肩关节脱位合并肱骨大结节骨折固定更加牢固,并发症更少,临床疗效好。
Objective To explore the results of proximal humeral locking plate combined with suture anchor in the treatment of shoulder dislocation with greater tuberosity fracture in the elderly patients. Methods From January2013 to October 2017, 30 elderly patients of shoulder dislocation and greater tuberosity fracture were divided into observation group and control group according to different surgery plans. After reduction of shoulder dislocation,the greater tuberosity displaced > 5 mm in all patients. Proximal humeral locking plate combined with suture anchor were used intraoperatively to reduce and fix the greater tuberosity and repair the rotator cuff in observation group,while proximal humeral locking plate was used only to fix the greater tuberosity. Preoperative and postoperative shoulder function was evaluated by range of motion, VAS score and Constant-Murley score. Results All patients were followed up for 12 to 18 months. There were no significant differences in the mean healing time between the 2 groups( P > 0.05). Postoperative VAS scores of the 2 groups were obviously lower than those of the corresponding groups preoperatively, the differences were statistically significant( P = 0.000); but there were no significant differences between the 2 groups postoperatively( P = 0.200). Postoperative Constant-Murley score of the 2 groups were obviously higher than those of the corresponding groups preoperatively, the differences were statistically significant( P = 0.000). Constant-Murley score of the observation group was obviously higher than that of the control group,the differences were statistically significant( P = 0.032). According to the functional rating, the excellent and good rate of the observation group was 86.67%, while that of the control group was only 66.67%. There were no obvious complications in the observation group, but 5 cases in the control group had displacement of fracture mass of humeral greater tuberosity and 2 cases had subacromial impingement syndrome. Conclusions Proximal humeral locking plate combined with suture anchor in the treatment of shoulder dislocation with greater tuberosity fracture in the elderly patients provides stable fixation with less complications.
Objective To explore the results of proximal humeral locking plate combined with suture anchor in the treatment of shoulder dislocation with greater tuberosity fracture in the elderly patients. Methods From January2013 to October 2017, 30 elderly patients of shoulder dislocation and greater tuberosity fracture were divided into observation group and control group according to different surgery plans. After reduction of shoulder dislocation,the greater tuberosity displaced > 5 mm in all patients. Proximal humeral locking plate combined with suture anchor were used intraoperatively to reduce and fix the greater tuberosity and repair the rotator cuff in observation group,while proximal humeral locking plate was used only to fix the greater tuberosity. Preoperative and postoperative shoulder function was evaluated by range of motion, VAS score and Constant-Murley score. Results All patients were followed up for 12 to 18 months. There were no significant differences in the mean healing time between the 2 groups( P > 0.05). Postoperative VAS scores of the 2 groups were obviously lower than those of the corresponding groups preoperatively, the differences were statistically significant( P = 0.000); but there were no significant differences between the 2 groups postoperatively( P = 0.200). Postoperative Constant-Murley score of the 2 groups were obviously higher than those of the corresponding groups preoperatively, the differences were statistically significant( P = 0.000). Constant-Murley score of the observation group was obviously higher than that of the control group,the differences were statistically significant( P = 0.032). According to the functional rating, the excellent and good rate of the observation group was 86.67%, while that of the control group was only 66.67%. There were no obvious complications in the observation group, but 5 cases in the control group had displacement of fracture mass of humeral greater tuberosity and 2 cases had subacromial impingement syndrome. Conclusions Proximal humeral locking plate combined with suture anchor in the treatment of shoulder dislocation with greater tuberosity fracture in the elderly patients provides stable fixation with less complications.
引文
[1]Dimakopoulos P,Panugopoulos H,Kasimatis G,et al.Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture:the necessity of operative treatment[J].J Orthop Trauma,2007,21(2):104-112.
[2]Bahrs C,Lingenfelter E,Fischer F,et al.Mechanism of injury and morphology of the greater tuberosity fracture[J].J Shoulder Elbow Surg,2006,15(2):140-147.
[3]Kaspar S,Mandel S.Acromial impression fracture of the greater tuberosity with rotator cuff avulsion due to hyperabduction injury of the shoulder[J].J Shoulder Elbow Surg,2004,13(1):112-114.
[4]Mutch J,Laflamme GY,Hagemeister N,et al.A new morphological classification for greater tuberosity fractures of the proximal humerus:validation and clinical implications[J].J Bone Joint,2014,96-B(5):646-651.
[5]Bono CM,Renard R,Levine RG,et al.Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder[J].J Bone Joint Surg(Br),2001,83(7):1056-1062.
[6]Gurson KI,Ruchelsman DE,Tejwani NC.Isolated tuberosity fractures of the proximal humerus:Current concepts[J].Injury,2008,39(3):284-298.
[7]Neer CS 2nd.Displaced proximal humeral fractures.I.Classification and evaluation[J].J Bone Joint Surg Am,1970,52(6):1077-1089.
[8]Park TS,Choi IY,Kim YH,et al.A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus[J].Bull Hosp Jt Dis,1997,56(3):171-176.
[9]Platzer P,Thalhammer G,Oberleitner G,et al.Displaced fractures of the greater tuberosity:a comparison of operative and nonoperative treatment[J].J Trauma,2008,65(4):843-848.
[10]Bhatia DN,van Rooyen KS,du Toit DF,et al.Surgical treatment of comminuted,displaced fractures of the greater tuberosity of the proximal humerus:a new technique of doublerow suture-anchor fixation and long-term results[J].Injury,2006,37(10):946-952.
[11]Lin CL,Hong CK,Jou IM,et al.Suture anchor versus screw fixation for greater tuberosity fractures of the humerus--a biomechanical study[J].J Orthop Res,2012,30(3):423-428.
[12]陈晓东,王宇仁,崔一民,等.锁定钢板治疗肱骨近端粉碎性骨折[J].中华手外科杂志,2008,24:203-205.
[13]陈晓东,崔一民,王宇仁,等.锁定钢板治疗肱骨近端骨折及内侧支撑的意义[J].中华手外科杂志,2009,25(6):332-334.
[14]Greiwe RM,Archdeacon MT.Locking plate technology:current concepts[J].J Knee Surg,2007,20(1):50-55.
[15]Sproul RC,Iyengar JJ,Devcic Z,et al.A systematic review of locking plate fixation of proximal humerus fractures[J].Injury,2011,42(4):408-413.
[16]Thanasas C,Kontakis G,Angoules A,et al.Treatment of proximal humerus fractures with locking plates:a systematic review[J].J Shoulder Elbow Surg,2009,18(6):837-844.
[17]Chen YF,Zhang W,Chen Q,et al.AO X-shaped midfoot locking plate to treat displaced isolated greater tuberosity fractures[J].Orthopedics,2013,36(8):e995-999.
[18]Hu C,Zhou K,Pan F,et al.Application of pre-contoured anatomic locking plate for treatment of humerus split type greater tuberosity fracture:A prospective review of 68 cases with an average follow-up of 2.5 years[J].Injury,2018,49(6):1108-1112.
[2]Bahrs C,Lingenfelter E,Fischer F,et al.Mechanism of injury and morphology of the greater tuberosity fracture[J].J Shoulder Elbow Surg,2006,15(2):140-147.
[3]Kaspar S,Mandel S.Acromial impression fracture of the greater tuberosity with rotator cuff avulsion due to hyperabduction injury of the shoulder[J].J Shoulder Elbow Surg,2004,13(1):112-114.
[4]Mutch J,Laflamme GY,Hagemeister N,et al.A new morphological classification for greater tuberosity fractures of the proximal humerus:validation and clinical implications[J].J Bone Joint,2014,96-B(5):646-651.
[5]Bono CM,Renard R,Levine RG,et al.Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder[J].J Bone Joint Surg(Br),2001,83(7):1056-1062.
[6]Gurson KI,Ruchelsman DE,Tejwani NC.Isolated tuberosity fractures of the proximal humerus:Current concepts[J].Injury,2008,39(3):284-298.
[7]Neer CS 2nd.Displaced proximal humeral fractures.I.Classification and evaluation[J].J Bone Joint Surg Am,1970,52(6):1077-1089.
[8]Park TS,Choi IY,Kim YH,et al.A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus[J].Bull Hosp Jt Dis,1997,56(3):171-176.
[9]Platzer P,Thalhammer G,Oberleitner G,et al.Displaced fractures of the greater tuberosity:a comparison of operative and nonoperative treatment[J].J Trauma,2008,65(4):843-848.
[10]Bhatia DN,van Rooyen KS,du Toit DF,et al.Surgical treatment of comminuted,displaced fractures of the greater tuberosity of the proximal humerus:a new technique of doublerow suture-anchor fixation and long-term results[J].Injury,2006,37(10):946-952.
[11]Lin CL,Hong CK,Jou IM,et al.Suture anchor versus screw fixation for greater tuberosity fractures of the humerus--a biomechanical study[J].J Orthop Res,2012,30(3):423-428.
[12]陈晓东,王宇仁,崔一民,等.锁定钢板治疗肱骨近端粉碎性骨折[J].中华手外科杂志,2008,24:203-205.
[13]陈晓东,崔一民,王宇仁,等.锁定钢板治疗肱骨近端骨折及内侧支撑的意义[J].中华手外科杂志,2009,25(6):332-334.
[14]Greiwe RM,Archdeacon MT.Locking plate technology:current concepts[J].J Knee Surg,2007,20(1):50-55.
[15]Sproul RC,Iyengar JJ,Devcic Z,et al.A systematic review of locking plate fixation of proximal humerus fractures[J].Injury,2011,42(4):408-413.
[16]Thanasas C,Kontakis G,Angoules A,et al.Treatment of proximal humerus fractures with locking plates:a systematic review[J].J Shoulder Elbow Surg,2009,18(6):837-844.
[17]Chen YF,Zhang W,Chen Q,et al.AO X-shaped midfoot locking plate to treat displaced isolated greater tuberosity fractures[J].Orthopedics,2013,36(8):e995-999.
[18]Hu C,Zhou K,Pan F,et al.Application of pre-contoured anatomic locking plate for treatment of humerus split type greater tuberosity fracture:A prospective review of 68 cases with an average follow-up of 2.5 years[J].Injury,2018,49(6):1108-1112.