微创空心钉与切开复位钢板内固定治疗肱骨大结节骨折的疗效比较_《中国修复重建外科杂志》

作者：

曹烈虎 , 翁蔚宗 , 宋绍军 , 李海航 , 苏佳灿

第二军医大学附属长海医院骨科（上海，200433）;

关键词：

肱骨大结节骨折微创手术内固定空心钉钢板

DOI：

10.7507/1002-1892.20130097

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的采用对比研究比较微创空心钉与切开复位钢板内固定治疗肱骨大结节骨折的疗效。方法将2008年1月－2011年1月收治并符合选择标准的49例肱骨大结节骨折患者随机分为两组，其中25例采用微创空心钉内固定，作为试验组；24例采用切开复位钢板内固定，作为对照组。两组患者性别、年龄、致伤原因、侧别、受伤至手术时间、骨折移位及合并症等一般资料比较，差异均无统计学意义（P gt; 0.05），具有可比性。记录两组切口长度、手术时间、术中出血量及住院时间。随访时按照肩关节Neer评分标准评定疗效，摄X线片观察骨折愈合情况。结果与对照组比较，试验组手术切口、手术时间以及住院时间短，术中出血量少，比较差异均有统计学意义（P lt; 0.01）。术后对照组2例出现切口浅表感染，经对症处理后愈合；其余患者切口均Ⅰ期愈合。两组患者均获随访，随访时间1～4年，平均2.3年。X线片复查示，两组骨折均愈合，愈合时间试验组为（7.0 ± 2.3）周，对照组为（7.8 ± 2.1）周，比较差异无统计学意义（t=1.24，P=0.22）。随访期间两组均无异位骨化及内固定物松动、断裂发生。末次随访时，试验组肩关节功能Neer评分为（86.3 ± 2.8）分，显著高于对照组的（80.1 ± 2.1）分，比较差异有统计学意义（t=6.37，P=0.00）。试验组获优14例，良8例，可2例，差1例，优良率88.0%；对照组获优12例，良7例，可2例，差3例，优良率79.2%；两组比较差异无统计学意义（Z=0.83，P=0.41）。结论与切开复位钢板内固定相比，微创空心钉内固定治疗肱骨大结节骨折具有手术操作简便、损伤小、术中出血少、术后肩关节功能恢复好等优点。

引用本文： 曹烈虎,翁蔚宗,宋绍军,李海航,苏佳灿. 微创空心钉与切开复位钢板内固定治疗肱骨大结节骨折的疗效比较. 中国修复重建外科杂志, 2013, 27(4): 418-422. doi: 10.7507/1002-1892.20130097 复制

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.	黄志龙, 尹和平. 可吸收螺钉微创治疗肱骨大结节撕脱骨折疗效分析. 吉林医学, 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.	郭刚, 余斌, 陈滨, 等. 肱骨大结节移位骨折的的手术探讨. 中华创骨科杂志, 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.	张晋, 鲁谊, 朱以明, 等. 肩关节镜辅助经皮空心钉或缝合锚固定治疗肱骨大结节骨折. 中华创伤骨科杂志, 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. 黄志龙, 尹和平. 可吸收螺钉微创治疗肱骨大结节撕脱骨折疗效分析. 吉林医学, 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. 郭刚, 余斌, 陈滨, 等. 肱骨大结节移位骨折的的手术探讨. 中华创骨科杂志, 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. 张晋, 鲁谊, 朱以明, 等. 肩关节镜辅助经皮空心钉或缝合锚固定治疗肱骨大结节骨折. 中华创伤骨科杂志, 2010, 12(4): 303-307.

《中国修复重建外科杂志》

微创空心钉与切开复位钢板内固定治疗肱骨大结节骨折的疗效比较

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《中国修复重建外科杂志》

微创空心钉与切开复位钢板内固定治疗肱骨大结节骨折的疗效比较

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