切开复位锁定加压钩钢板治疗单纯肱骨大结节骨折疗效分析
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摘要
目的探讨切开复位锁定加压钩钢板治疗单纯肱骨大结节骨折的疗效。方法 2014年3月—2017年9月,收治16例单纯肱骨大结节骨折患者。男11例,女5例;年龄22～67岁,平均38.4岁。致伤原因:摔伤13例,运动伤3例;均为闭合性损伤。CT示复位后骨折移位8～21 mm,平均12.6 mm。14例伴肩关节脱位。受伤至手术时间为2～5 d,平均2.6 d。所有患者均采用切开复位锁定加压钩钢板固定治疗,术后第3天开始肩关节功能锻炼。结果术后患者切口均Ⅰ期愈合,无感染、神经损伤等并发症发生。患者均获随访,随访时间12～20个月,平均15.3个月。术后3个月X线片复查示骨折愈合,均达影像学解剖复位标准。末次随访时,根据Neer评分评价肩关节功能,获优11例、良5例。其中1例术后出现肩关节轻微疼痛,伴轻度活动受限,1年后疼痛症状消失。结论对于单纯肱骨大结节骨折,切开复位锁定加压钩钢板固定治疗具有术中出血少、骨折固定牢固、允许早期功能锻炼等优点,有利于肩关节功能恢复,获得较好疗效。
Objective To observe the effectiveness of locking compression hook plate in treatment of humeral greater tuberosity fractures. Methods Between March 2014 and September 2017, 16 patients with isolated humeral greater tuberosity fractures were terated with open reduction and internal fixation with locking compression hook plates.There were 11 males and 5 females, with an average age of 38.4 years(range, 22-67 years). The cause of injury was falling injury in 13 cases and sport injury in 3 cases. All patients were closed fractures. Of all patients, 14 patients accompanied with shoulder joint dislocations. CT scan showed the average displacement of fragment was 12.6 mm(range, 8-21 mm)after reduction. All patients began passive functional exercise at 3 days after operation. Results Primary healing of the incisons achieved in all patients, without complications such as infection and nerve injury. All patients were followed up12-20 months(mean, 15.3 months). At 3 months after operation, X-ray film showed that all fractures achieved bone union, all of which met the imaging anatomical reduction standard. According to the Neer scoring criteria, 11 cases were excellent and 5 cases were good at last follow-up. One patint presented slight pain of shoulder joint and mild activity limitation, which relieved after 1 year. Conclusion The method of open reduction and locking compression hook plate internal fixation for isolated humeral greater tuberosity fractures has advantages, such as less intraoperative hemorrhage,mild postoperative pain, firm fixation, and allowing patients to perform functional exercise earlier, which is conducive to shoulder functional recovery and obtain satisfactory effectiveness.
Objective To observe the effectiveness of locking compression hook plate in treatment of humeral greater tuberosity fractures. Methods Between March 2014 and September 2017, 16 patients with isolated humeral greater tuberosity fractures were terated with open reduction and internal fixation with locking compression hook plates.There were 11 males and 5 females, with an average age of 38.4 years(range, 22-67 years). The cause of injury was falling injury in 13 cases and sport injury in 3 cases. All patients were closed fractures. Of all patients, 14 patients accompanied with shoulder joint dislocations. CT scan showed the average displacement of fragment was 12.6 mm(range, 8-21 mm)after reduction. All patients began passive functional exercise at 3 days after operation. Results Primary healing of the incisons achieved in all patients, without complications such as infection and nerve injury. All patients were followed up12-20 months(mean, 15.3 months). At 3 months after operation, X-ray film showed that all fractures achieved bone union, all of which met the imaging anatomical reduction standard. According to the Neer scoring criteria, 11 cases were excellent and 5 cases were good at last follow-up. One patint presented slight pain of shoulder joint and mild activity limitation, which relieved after 1 year. Conclusion The method of open reduction and locking compression hook plate internal fixation for isolated humeral greater tuberosity fractures has advantages, such as less intraoperative hemorrhage,mild postoperative pain, firm fixation, and allowing patients to perform functional exercise earlier, which is conducive to shoulder functional recovery and obtain satisfactory effectiveness.
引文
1 Kim E, Shin HK, Kim CH. Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci, 2005, 10(5):441-444.
2 Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral:current concepts. Injury, 2008,39(3):284-298.
3李文庆,张作君,刘云龙.肱骨近端脱套样骨折治疗体会.中国修复重建外科杂志,2018, 32(12):1540-1544.
4 Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg, 2003,12(6):641-649.
5 Williams GR Jr, Wong KL. Two-part and three-part fractures:open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am, 2000, 31(1):1-21.
6 Platzer P, Kutscha-Lissberg F, Lehr S, et al. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury, 2005, 36(10):1185-1189.
7 Yin B, Moen TC, Thompson SA, et al. Operative treatment of isolated greater tuberosity fractures:retrospective review of clinical and functional outcomes. Orthopedics, 2012, 35(6):e807-e814.
8 Mutch J, Laflamme GY, Hagemeister N, et al. A new morphological classification for greater tuberosity fractures of the proximal humerus:validation and clinical implications. Bone Joint J,2014, 96-B(5):646-651.
9 Neer CS 2nd. Displaced proximal humeral fractures:part I.Classification and evaluation. 1970. Clin Orthop Relat Res, 2006,(442):77-82.
10 Mason BJ, Kier R, Bindleglass DF. Occult fractures of the greater tuberosity of the humerus:radiographic and MR imaging findings.AJR Am J Roentgenol, 1999,172(2):469-473.
11 Gumina S, Carbone S, Postacchini F. Occult fractures of the greater tuberosity of the humerus. Int Orthop, 2009, 33(1):171-174.
12 Zanetti M, Weishaupt D, Jost B, et al. MR imaging for traumatic tears of the rotator cuff:high prevalence of greater tuberosity fractures and subscapularis tendon tears. AJR Am J Roentgenol,1999,172(2):463-467.
13 Mattyasovszky SG, Burkhart KJ, Ahlers C, et al. Isolated fractures of the greater tuberosity of the proximal humerus:a long-term retrospective study of 30 patients. Acta Orthop, 2011, 82(6):714-720.
14 White EA, Skalski MR, Patel DB, et al. Isolated greater tuberosity fractures of the proximal humerus:anatomy, injury patterns,multimodality imaging, and approach to management. Emerg Radiol, 2018, 25(3):235-246.
15 Patten RM, Mack LA, Wang KY, et al. Nondisplaced fractures of the greater tuberosity of the humerus:sonographic detection.Radiology, 1992, 182(1):201-204.
16 Rutten MJ, Jager GJ, de Waal Malefijt MC, et al. Double line sign:a helpful sonographic sign to detect occult fractures of the proximal humerus. Eur Radiol, 2007, 17(3):762-767.
17 Liao W, Zhang H, Li Z, et al. Is arthroscopic technique superior to open reduction internal fixation in the treatment of isolated displaced greater tuberosity fractures? Clin Orthop Relat Res, 2016,474(5):1269-1279.
18 Schoffl V, Popp D, Strecker W. A simple and effective implant for displaced fractures of the greater tuberosity:the"Bamberg"plate.Arch Orthop Trauma Surg, 2011, 131(4):509-512.
19 Dimakopoulos P, Panagopoulos A, Kasimatis G, et al. Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture:the necessity of operative treatment. J Orthop Trauma, 2007, 21(2):104-112.
20 Gaudelli C, Menard J, Mutch J, et al. Locking plate fixation provides superior fixation of humerus split type greater tuberosity fractures than tension bands and double row suture bridges. Clin Biomech(Bristol, Avon), 2014, 29(9):1003-1008.
2 Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral:current concepts. Injury, 2008,39(3):284-298.
3李文庆,张作君,刘云龙.肱骨近端脱套样骨折治疗体会.中国修复重建外科杂志,2018, 32(12):1540-1544.
4 Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg, 2003,12(6):641-649.
5 Williams GR Jr, Wong KL. Two-part and three-part fractures:open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am, 2000, 31(1):1-21.
6 Platzer P, Kutscha-Lissberg F, Lehr S, et al. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury, 2005, 36(10):1185-1189.
7 Yin B, Moen TC, Thompson SA, et al. Operative treatment of isolated greater tuberosity fractures:retrospective review of clinical and functional outcomes. Orthopedics, 2012, 35(6):e807-e814.
8 Mutch J, Laflamme GY, Hagemeister N, et al. A new morphological classification for greater tuberosity fractures of the proximal humerus:validation and clinical implications. Bone Joint J,2014, 96-B(5):646-651.
9 Neer CS 2nd. Displaced proximal humeral fractures:part I.Classification and evaluation. 1970. Clin Orthop Relat Res, 2006,(442):77-82.
10 Mason BJ, Kier R, Bindleglass DF. Occult fractures of the greater tuberosity of the humerus:radiographic and MR imaging findings.AJR Am J Roentgenol, 1999,172(2):469-473.
11 Gumina S, Carbone S, Postacchini F. Occult fractures of the greater tuberosity of the humerus. Int Orthop, 2009, 33(1):171-174.
12 Zanetti M, Weishaupt D, Jost B, et al. MR imaging for traumatic tears of the rotator cuff:high prevalence of greater tuberosity fractures and subscapularis tendon tears. AJR Am J Roentgenol,1999,172(2):463-467.
13 Mattyasovszky SG, Burkhart KJ, Ahlers C, et al. Isolated fractures of the greater tuberosity of the proximal humerus:a long-term retrospective study of 30 patients. Acta Orthop, 2011, 82(6):714-720.
14 White EA, Skalski MR, Patel DB, et al. Isolated greater tuberosity fractures of the proximal humerus:anatomy, injury patterns,multimodality imaging, and approach to management. Emerg Radiol, 2018, 25(3):235-246.
15 Patten RM, Mack LA, Wang KY, et al. Nondisplaced fractures of the greater tuberosity of the humerus:sonographic detection.Radiology, 1992, 182(1):201-204.
16 Rutten MJ, Jager GJ, de Waal Malefijt MC, et al. Double line sign:a helpful sonographic sign to detect occult fractures of the proximal humerus. Eur Radiol, 2007, 17(3):762-767.
17 Liao W, Zhang H, Li Z, et al. Is arthroscopic technique superior to open reduction internal fixation in the treatment of isolated displaced greater tuberosity fractures? Clin Orthop Relat Res, 2016,474(5):1269-1279.
18 Schoffl V, Popp D, Strecker W. A simple and effective implant for displaced fractures of the greater tuberosity:the"Bamberg"plate.Arch Orthop Trauma Surg, 2011, 131(4):509-512.
19 Dimakopoulos P, Panagopoulos A, Kasimatis G, et al. Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture:the necessity of operative treatment. J Orthop Trauma, 2007, 21(2):104-112.
20 Gaudelli C, Menard J, Mutch J, et al. Locking plate fixation provides superior fixation of humerus split type greater tuberosity fractures than tension bands and double row suture bridges. Clin Biomech(Bristol, Avon), 2014, 29(9):1003-1008.