缝线辅助小钢板微创内固定治疗肱骨大结节骨折
摘要
目的探讨小切口缝线辅助小钢板内固定治疗肱骨大结节骨折的临床疗效。方法回顾性分析自2015-01—2017-12诊治的21例肱骨大结节骨折,采用经肩峰前1/4外侧三角肌小切口,通过缝线牵拉复位骨折块,然后再用克氏针临时固定,透视骨折复位满意后将牵引固定肩袖的缝线穿入合适型号的小钢板缝线孔中,小钢板固定肱骨大结节骨折。结果 21例均获得随访,随访时间平均16(12～26)个月。术后3个月所有患者骨折均达到骨性愈合。3例骨折愈合后出现肩关节僵硬,嘱患者积极功能锻炼后改善。末次随访时肩关节活动度:前屈125°～160°,平均147.1°;外展120°～170°,平均144.8°;外旋15°～50°,平均32.4°;内旋10°～15°,平均11.7°。末次随访时肩关节功能ASES评分86～96分,平均92.7分;UCLA评分30～35分,平均34.3分。结论采用经肩峰前1/4外侧三角肌小切口缝线辅助小钢板内固定治疗肱骨大结节骨折具有创伤小、骨折复位满意、固定牢靠、避免肩峰下撞击、允许早期功能锻炼等优点。
引文
[1]Park SE,Jeong JJ,Panchal K,et al.Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus:a novel surgical technique[J].Knee Surg Sports Traumatol Arthrosc,2016,24(12):3892-3898.
[2]张中兴,许峰,杨小龙.关节镜下肩峰成形附加大结节成形术治疗肩峰下撞击综合征[J].中国骨与关节损伤杂志,2017,32(5):525-526.
[3]DeBottis D,Anavian J,Green A.Surgical management of isolated greater tuberosity fractures of the proximal humerus[J].Orthop Clin North Am,2014,45(2):207-218.
[4]张学东,毛勇,王海龙,等.微创肱骨近端锁定接骨板与空心钉内固定治疗肱骨大结节劈裂骨折疗效比较[J].中国骨与关节损伤杂志,2017,32(5):533-535.
[5]Hebert-Davies J,Mutch J,Rouleau D,et al.Delayed migration of greater tuberosity fractures associated with anterior shoulder dislocation[J].J Orthop Trauma,2015,29(10):e396-400.
[6]Cvetanovich GL,Chalmers PN,Verma NN,et al.Open reduction internal fixation has fewer short-term complications than shoulder arthroplasty for proximal humeral fractures[J].J Shoulder Elbow Surg,2016,25(4):624-631.
[7]Pauly S,Herrmann S,Perka C,et al.Arthroscopic refixation of a combined fracture of the greater and lesser tuberosity of the proximal humerus[J].Knee Surg Sports Traumat Arthrosc,2013,21(5):1175.
[8]Buecking B,Mohr J,Bockmann B,et al.Deltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures?[J].Clin Orthop Relat Res,2014,472(5):1576-1585.
[9]李乾,谢勇,李雪莲.两种入路治疗肱骨大结节撕脱骨折的疗效比较[J].现代临床医学,2017,43(3):197-198.
[10]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?[J].Clin Orthop Relat Res,2016,474(5):1269-1279.
[2]张中兴,许峰,杨小龙.关节镜下肩峰成形附加大结节成形术治疗肩峰下撞击综合征[J].中国骨与关节损伤杂志,2017,32(5):525-526.
[3]DeBottis D,Anavian J,Green A.Surgical management of isolated greater tuberosity fractures of the proximal humerus[J].Orthop Clin North Am,2014,45(2):207-218.
[4]张学东,毛勇,王海龙,等.微创肱骨近端锁定接骨板与空心钉内固定治疗肱骨大结节劈裂骨折疗效比较[J].中国骨与关节损伤杂志,2017,32(5):533-535.
[5]Hebert-Davies J,Mutch J,Rouleau D,et al.Delayed migration of greater tuberosity fractures associated with anterior shoulder dislocation[J].J Orthop Trauma,2015,29(10):e396-400.
[6]Cvetanovich GL,Chalmers PN,Verma NN,et al.Open reduction internal fixation has fewer short-term complications than shoulder arthroplasty for proximal humeral fractures[J].J Shoulder Elbow Surg,2016,25(4):624-631.
[7]Pauly S,Herrmann S,Perka C,et al.Arthroscopic refixation of a combined fracture of the greater and lesser tuberosity of the proximal humerus[J].Knee Surg Sports Traumat Arthrosc,2013,21(5):1175.
[8]Buecking B,Mohr J,Bockmann B,et al.Deltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures?[J].Clin Orthop Relat Res,2014,472(5):1576-1585.
[9]李乾,谢勇,李雪莲.两种入路治疗肱骨大结节撕脱骨折的疗效比较[J].现代临床医学,2017,43(3):197-198.
[10]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?[J].Clin Orthop Relat Res,2016,474(5):1269-1279.