微創空心釘與切開復位鋼板內固定治療肱骨大結節骨折的療效比較_《中國修復重建外科雜志》

作者：

曹烈虎 , 翁蔚宗 , 宋紹軍 , 李海航 , 蘇佳燦

第二軍醫大學附屬長海醫院骨科（上海，200433）;

關鍵詞：

肱骨大結節骨折微創手術內固定空心釘鋼板

DOI：

10.7507/1002-1892.20130097

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目的采用對比研究比較微創空心釘與切開復位鋼板內固定治療肱骨大結節骨折的療效。方法將2008年1月－2011年1月收治并符合選擇標準的49例肱骨大結節骨折患者隨機分為兩組，其中25例采用微創空心釘內固定，作為試驗組；24例采用切開復位鋼板內固定，作為對照組。兩組患者性別、年齡、致傷原因、側別、受傷至手術時間、骨折移位及合并癥等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。記錄兩組切口長度、手術時間、術中出血量及住院時間。隨訪時按照肩關節Neer評分標準評定療效，攝X線片觀察骨折愈合情況。結果與對照組比較，試驗組手術切口、手術時間以及住院時間短，術中出血量少，比較差異均有統計學意義（P lt; 0.01）。術后對照組2例出現切口淺表感染，經對癥處理后愈合；其余患者切口均Ⅰ期愈合。兩組患者均獲隨訪，隨訪時間1～4年，平均2.3年。X線片復查示，兩組骨折均愈合，愈合時間試驗組為（7.0 ± 2.3）周，對照組為（7.8 ± 2.1）周，比較差異無統計學意義（t=1.24，P=0.22）。隨訪期間兩組均無異位骨化及內固定物松動、斷裂發生。末次隨訪時，試驗組肩關節功能Neer評分為（86.3 ± 2.8）分，顯著高于對照組的（80.1 ± 2.1）分，比較差異有統計學意義（t=6.37，P=0.00）。試驗組獲優14例，良8例，可2例，差1例，優良率88.0%；對照組獲優12例，良7例，可2例，差3例，優良率79.2%；兩組比較差異無統計學意義（Z=0.83，P=0.41）。結論與切開復位鋼板內固定相比，微創空心釘內固定治療肱骨大結節骨折具有手術操作簡便、損傷小、術中出血少、術后肩關節功能恢復好等優點。

引用本文： 曹烈虎,翁蔚宗,宋紹軍,李海航,蘇佳燦. 微創空心釘與切開復位鋼板內固定治療肱骨大結節骨折的療效比較. 中國修復重建外科雜志, 2013, 27(4): 418-422. doi: 10.7507/1002-1892.20130097 復制

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.	Court-rown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Seand, 2001, 72(4): 365-371.
3.	George MS. Fractures of the greater tuberosity of the humerus. J Am Acad Orthop Surg, 2007, 15(10): 607-613.
4.	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.
5.	黃志龍, 尹和平. 可吸收螺釘微創治療肱骨大結節撕脫骨折療效分析. 吉林醫學, 2011, 32(4): 708-709.
6.	Platzer P, Thalhammer G, Oberleitner G, et al. Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment. J Trauma, 2008, 65(4): 843-848.
7.	Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg (Am), 1970, 52(6): 1077-1089.
8.	Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Should Elbow Surg, 2003, 12(6): 641-649.
9.	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. Bull Hosp Jt Dis, 1997, 56(3): 171-176.
10.	Crowell MS, Plank RJ. Fractures of the greater tuberosity of the humerus. J Orthop Sports Phys Ther, 2010, 40(7): 447.
11.	Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral: current concepts. Injury, 2008, 39(3): 284-298.
12.	Platzer P, Thalhammer G, Oberleitner G, et al. Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment. Trauma, 2008, 65(4): 843-848.
13.	Gartsman GM, Tavema E, Hamraerman SM. Arthroscopic treatment of acute traumatic anterior glenohumeral dislocation and greater tuberosity fracture. Arthroscopy, 1999, 15(6): 648-650.
14.	Schai PA, Hintermmann B, Koris MJ. Preoperative arthroscopic assessment of fractures about the shoulder. Arthroscopy, 1999, 15(8): 827-835.
15.	Gerber C, Schneeberger AG, Vinh TS. The arterial vascularization of the humeral head. An anatomical stray. J Bone Joint Surg (Am), 1990, 72(10): 1486-1494.
16.	Lill H, Lange K, Prasse-Badde J, et al. T-plate osteosynthesis in dislocated proximal humerus fractures. Unfallchirurgie, 1997, 23(5): 183-192.
17.	郭剛, 余斌, 陳濱, 等. 肱骨大結節移位骨折的的手術探討. 中華創骨科雜志, 2012, 14(8): 685-688.
18.	Flatow EL, Cuomo F, Maday MG, et al. Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. J Bone Joint Surg (Am), 1991, 73(8): 1213-1218.
19.	張晉, 魯誼, 朱以明, 等. 肩關節鏡輔助經皮空心釘或縫合錨固定治療肱骨大結節骨折. 中華創傷骨科雜志, 2010, 12(4): 303-307.

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. Court-rown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Seand, 2001, 72(4): 365-371.
3. George MS. Fractures of the greater tuberosity of the humerus. J Am Acad Orthop Surg, 2007, 15(10): 607-613.
4. 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.
5. 黃志龍, 尹和平. 可吸收螺釘微創治療肱骨大結節撕脫骨折療效分析. 吉林醫學, 2011, 32(4): 708-709.
6. Platzer P, Thalhammer G, Oberleitner G, et al. Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment. J Trauma, 2008, 65(4): 843-848.
7. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg (Am), 1970, 52(6): 1077-1089.
8. Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Should Elbow Surg, 2003, 12(6): 641-649.
9. 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. Bull Hosp Jt Dis, 1997, 56(3): 171-176.
10. Crowell MS, Plank RJ. Fractures of the greater tuberosity of the humerus. J Orthop Sports Phys Ther, 2010, 40(7): 447.
11. Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral: current concepts. Injury, 2008, 39(3): 284-298.
12. Platzer P, Thalhammer G, Oberleitner G, et al. Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment. Trauma, 2008, 65(4): 843-848.
13. Gartsman GM, Tavema E, Hamraerman SM. Arthroscopic treatment of acute traumatic anterior glenohumeral dislocation and greater tuberosity fracture. Arthroscopy, 1999, 15(6): 648-650.
14. Schai PA, Hintermmann B, Koris MJ. Preoperative arthroscopic assessment of fractures about the shoulder. Arthroscopy, 1999, 15(8): 827-835.
15. Gerber C, Schneeberger AG, Vinh TS. The arterial vascularization of the humeral head. An anatomical stray. J Bone Joint Surg (Am), 1990, 72(10): 1486-1494.
16. Lill H, Lange K, Prasse-Badde J, et al. T-plate osteosynthesis in dislocated proximal humerus fractures. Unfallchirurgie, 1997, 23(5): 183-192.
17. 郭剛, 余斌, 陳濱, 等. 肱骨大結節移位骨折的的手術探討. 中華創骨科雜志, 2012, 14(8): 685-688.
18. Flatow EL, Cuomo F, Maday MG, et al. Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. J Bone Joint Surg (Am), 1991, 73(8): 1213-1218.
19. 張晉, 魯誼, 朱以明, 等. 肩關節鏡輔助經皮空心釘或縫合錨固定治療肱骨大結節骨折. 中華創傷骨科雜志, 2010, 12(4): 303-307.

《中國修復重建外科雜志》

微創空心釘與切開復位鋼板內固定治療肱骨大結節骨折的療效比較

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《中國修復重建外科雜志》

微創空心釘與切開復位鋼板內固定治療肱骨大結節骨折的療效比較

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