单排锚钉联合骨隧道与双排锚钉治疗肱骨大结节骨折的临床研究

doi:10.11958/20221971

天津医药 ›› 2023, Vol. 51 ›› Issue (7): 746-750.doi: 10.11958/20221971

单排锚钉联合骨隧道与双排锚钉治疗肱骨大结节骨折的临床研究

刘国印¹(), 吕德珍², 冷楠楠¹, 柏天婷¹, 王永强³, 陈建民¹, 汪勇⁴^,^△()

1 南京医科大学金陵临床医学院骨科（邮编210002）
2 南京医科大学金陵临床医学院麻醉科（邮编210002）
3 南京医科大学金陵临床医学院康复科（邮编210002）
4 南京医科大学金陵临床医学院门诊部（邮编210002）

收稿日期:2022-11-30 修回日期:2023-03-01 出版日期:2023-07-15 发布日期:2023-07-18
通讯作者: ^△汪勇 E-mail:282917354@qq.com
作者简介:刘国印（1987），男，主治医师，主要从事创伤骨科和关节外科的基础和临床方面研究。E-mail：liuguoyin0425@163.com
基金资助:
国家自然科学基金青年科学基金项目(82102547);江苏省自然科学基金面上项目(BK20181113)

A clinical analysis of single row anchor combined with bone tunnel and double row anchor in the treatment of humerus greater tuberosity fracture

LIU Guoyin¹(), LYU Dezhen², LENG Nannan¹, BAI Tianting¹, WANG Yongqiang³, CHEN Jianmin¹, WANG Yong⁴^,^△()

1 Department of Orthopaedics, Jinling Hospital of Nanjing Medical University, Nanjing 210002, China
2 Department of Anesthesiology, Jinling Hospital of Nanjing Medical University, Nanjing 210002, China
3 Department of Rehabilitation, Jinling Hospital of Nanjing Medical University, Nanjing 210002, China
4 Department of Outpatient, Jinling Hospital of Nanjing Medical University, Nanjing 210002, China

Received:2022-11-30 Revised:2023-03-01 Published:2023-07-15 Online:2023-07-18
Contact: ^△WANG Yong E-mail:282917354@qq.com

刘国印, 吕德珍, 冷楠楠, 柏天婷, 王永强, 陈建民, 汪勇. 单排锚钉联合骨隧道与双排锚钉治疗肱骨大结节骨折的临床研究[J]. 天津医药, 2023, 51(7): 746-750.

LIU Guoyin, LYU Dezhen, LENG Nannan, BAI Tianting, WANG Yongqiang, CHEN Jianmin, WANG Yong. A clinical analysis of single row anchor combined with bone tunnel and double row anchor in the treatment of humerus greater tuberosity fracture[J]. Tianjin Medical Journal, 2023, 51(7): 746-750.

摘要/Abstract

摘要：

目的探讨单排锚钉联合骨隧道（SRA-BT）与双排锚钉（DRA）治疗肱骨大结节骨折（GTF）的临床疗效。方法回顾性分析40例接受锚钉固定技术治疗的GTF患者的临床资料，根据医患沟通结果和锚钉固定方式分为SRA-BT组（18例）和DRA组（22例），SRA-BT组采用内排锚钉联合骨隧道的缝线桥固定技术，DRA组采用内排锚钉联合外排锚钉的缝线桥固定技术。比较2组患者围手术期和术后相关指标、并发症、术后肱骨大结节位移距离；术后6个月时评估患者的肩关节疼痛程度、功能和活动度。结果患者均获得骨性愈合，未发生感染和内固定失败。2组患者手术时间、术中出血量、住院时间、骨折愈合时间、术后肱骨大结节位移距离和术后恢复日常生活时间差异均无统计学意义（P>0.05）。SRA-BT组切口长度较DRA组增大，住院总费用低于DRA组（P<0.05）。2组患者术后并发症发生情况间差异无统计学意义（P>0.05）。2组患者术后静息和活动时的疼痛视觉模拟评分和美国肩肘外科协会评分（ASES）均较术前明显改善（P<0.05），而术后2组间术后静息和活动时的疼痛视觉模拟评分、ASES评分及前屈、外展、0°外旋和90°内旋的活动度比较差异均无统计学意义（P>0.05）。结论 SRA-BT与DRA治疗GTF的临床疗效明确，均能有效提高肩关节功能并缓解术后疼痛，但SRA-BT在降低医疗费用上更具优势。

关键词: 肱骨, 大结节骨折, 单排锚钉, 双排锚钉, 骨隧道, 缝线桥

Abstract:

Objective To investigate the clinical effect of single row anchor (SRA) combined with bone tunnel (SRA-BT) and double row anchor (DRA) in the treatment of greater tuberosity fracture (GTF) of humerus. Methods The medical records of 40 patients with GTF treated with anchor fixation technique were retrospectively analyzed. Patients were divided into the SRA-BT group (18 cases) and the DRA group (22 cases) by surgical methods after doctor-patient communication. The suture bridge technique of SRA combined with bone tunnel was used in the SRA-BT group, and DRA with suture bridge was used in the DRA group. The perioperative and postoperative indicators, complications and postoperative displacement distance of the greater tuberosity were compared between the two groups. The pain degree, functional status and range of motion were assessed 6 months after surgery. Results Bone healing was achieved in all patients without infection or internal fixation failure. There were no significant differences in operative time, intraoperative blood loss, hospital stay, postoperative complications, bone healing time and postoperative displacement distance of the greater tuberosity between the two groups (P>0.05). The incision length was larger in the SRA-BT group than that of the DRA group (P<0.05). The in-patients costs was significantly lower in the SRA-BT group than that of the DRA group (P<0.05). There were no significant differences in postoperative complications between the two groups (P>0.05). The VAS score and ASES score at rest and activity were significantly improved after operation in both groups (P<0.05), but there were no significant differences in VAS score, ASES score and ranges of motion in flexion, abduction, 0°external rotation and 90° internal rotation at rest and activity after operation between the two groups (P>0.05). Conclusion The clinical effect of technology of SRA-BT and DRA have clear clinical efficacy in the treatment of GTF, and both of them could effectively improve shoulder joint function and relieve postoperative pain. However, the SRA-BT has more advantages in reducing medical costs.

Key words: humerus, greater tuberosity fractures, single row anchor, double row anchor, bone tunnel, suture bridge

中图分类号:

R683

图/表 6

参考文献 25

[1]	HUNTLEY S R, LEHTONEN E J, ROBIN J X, et al. Outcomes of surgical fixation of greater tuberosity fractures:A systematic review[J]. Orthop Traumatol Surg Res, 2020, 106(6):1119-1126. doi:10.1016/j.otsr.2020.05.005.
[2]	NYFFELER R W, SEIDEL A, WERLEN S, et al. Radiological and biomechanical assessment of displaced greater tuberosity fractures[J]. Int Orthop, 2019, 43(6):1479-1486. doi:10.1007/s00264-018-4170-x.
[3]	WHITE E A, SKALSKI M R, PATEL D B, et al. Isolated greater tuberosity fractures of the proximal humerus:anatomy,injury patterns,multimodality imaging,and approach to management[J]. Emerg Radiol, 2018, 25(3):235-246. doi:10.1007/s10140-018-1589-8.
[4]	LEVY D M, ERICKSON B J, HARRIS J D, et al. Management of isolated greater tuberosity fractures:A systematic review[J]. Am J Orthop(Belle Mead NJ), 2017, 46(6):E445-E453.
[5]	HOLT A M, FIELD L D. Arthroscopic management of displaced greater tuberosity fractures[J]. Arthrosc Tech, 2021, 10(4):e1055-e1060. doi:10.1016/j.eats.2020.12.006.
[6]	CHENG M F, HUNG S H, SU Y P, et al. Displaced isolated greater tuberosity fractures of elder adults treated with plate osteosynthesis[J]. J Chin Med Assoc, 2019, 82(4):318-321. doi:10.1097/JCMA.0000000000000049.
[7]	BAHMAN M, COSTIL V, GAUME M, et al. Arthroscopic reduction and fixation with a knotless double-row construct provides good results for displaced greater tuberosity fractures[J]. Arthrosc Sports Med Rehabil, 2021, 3(2):e499-e504. doi:10.1016/j.asmr.2020.10.014.
[8]	LI R, CAI M, TAO K. Arthroscopic reduction and fixation for displaced greater tuberosity fractures using the modified suture-bridge technique[J]. Int Orthop, 2017, 41(6):1257-1263. doi:10.1007/s00264-017-3461-y.
[9]	VAN WIER M F, AMAJJAR I, HAGEMEIJER N C, et al. Follow-up radiographs in isolated Greater Tuberosity fractures lead to a change in treatment recommendation;an online survey study[J]. Orthop Traumatol Surg Res, 2020, 106(2):255-259. doi:10.1016/j.otsr.2019.12.005.
[10]	王强, 顾勇, 陈亮. 带线锚钉与钢板内固定治疗肱骨大结节骨折的优劣分析[J]. 中国组织工程研究, 2020, 24(30):4813-4817.
	WANG Q, GU Y, CHEN L. Advantages and disadvantages of internal fixation with suture anchors and locking plate in the treatment of the greater tuberosity fracture[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(30):4813-4817. doi:10.3969/j.issn.2095-4344.2827.
[11]	帅永明, 曾凡辉, 涂淑强. 两种固定方式治疗粉碎性肱骨大结节骨折的对比[J]. 中国矫形外科杂志, 2020, 28(2):159-164.
	SHUAI Y M, ZENG F H, TU S Q. Double-row anchors versus locking proximal humeral plate for comminuted fracture of greater tuberosity[J]. Orthopedic Journal of China, 2020, 28(2):159-164. doi:10.3977/j.issn.1005-8478.2020.02.13.
[12]	白云鹏, 邱永敏, 丁菊红, 等. 双排锚钉缝线桥与空心拉力螺钉治疗老年肱骨大结节骨折的疗效比较[J]. 实用骨科杂志, 2020, 26(8):682-687.
	BAI Y P, QIU Y M, DING J H, et al. A comparative study on the efficacy of double-row suture anchor bridge and hollow lag screw in the treatment of elderly patients with greater tuberosity fracture[J]. Journal of Practical Orthopaedics, 2020, 26(8):682-687.
[13]	杨国勇, 向明, 陈杭, 等. 关节镜下中空螺钉和(或)锚钉缝线桥技术固定肱骨大结节骨折[J]. 中华骨科杂志, 2017, 37(21):1342-1349.
	YANG G Y, XIANG M, CHEN H, et al. Short-term functional outcome of arthroscopic reduction and fixation with cannulated screws and/or suture-bridge technique with double-row suture anchor for fractures of greater tuberosity[J]. Chinese Journal of Orthopaedics, 2017, 37(21):1342-1349. doi:10.3760/cma.j.issn.0253-2352.2017.21.005.
[14]	SEPPEL G, SAIER T, MARTETSCHLÄGER F, et al. Single versus double row suture anchor fixation for greater tuberosity fractures - a biomechanical study[J]. BMC Musculoskelet Disord, 2017, 18(1):506. doi:10.1186/s12891-017-1868-7.
[15]	CHOI S, SON I, HYUN M J, et al. Arthroscopic treatment of greater tuberosity fractures :Retrospective review of clinical and radiological outcomes[J]. Acta Orthop Belg, 2018, 84(1):47-53.
[16]	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. doi:10.1007/s11999-015-4663-5.
[17]	蔡贵泉, 何继业, 王晖, 等. 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[J]. 中国骨与关节杂志, 2019, 8(3):171-176.
	CAI G Y, HE J Y, WANG H, et al. Clinical observation of proximal humeral locking plate combined with suture anchor in the treatment of shoulder dislocation with greater tuberosity fracture in the elderly patients[J]. Chinese Journal of Bone and Joint, 2019, 8(3):171-176. doi:10.3969/j.issn.2095-252X.2019.03.003.
[18]	刘士凯, 郝连升, 穆胜凯. 劈裂型肱骨大结节骨折低切迹钢板固定与肩袖锚定[J]. 中国矫形外科杂志, 2022, 30(13):1220-1222.
	LIU S K, HAO L S, MU S K. Low-profile plate and rotator cuff anchoring for split-type humeral greater tuberosity fractures[J]. Orthopedic Journal of China, 2022, 30(13):1220-1222. doi:10.3977/j.issn.1005-8478.2022.13.15.
[19]	王尧, 曹烈虎, 陈晓, 等. 经三角肌小切口双排缝合锚钉与肱骨近端解剖钢板治疗肱骨大结节撕脱性骨折疗效的对比研究[J]. 中国骨与关节杂志, 2019, 8(3):165-170.
	WANG Y, CAO L H, CHEN X, et al. A clinical analysis of small incision through the deltoid muscle with double-row suture anchor fixtion versus proximal humerus anatomical plate for the treatment of avulsion fracture[J]. Chinese Journal of Bone and Joint, 2019, 8(3):165-170. doi:10.3969/j.issn.2095-252X.2019.03.002.
[20]	武翔, 李飞, 尹静, 等. 空心钉与接骨板内固定治疗肱骨大结节骨折疗效的Meta分析[J]. 中国骨伤, 2021, 34(2):180-190.
	WU X, LI F, YIN J, et al. Clinical effects between cannulated screw and bone plate internal fixation for humeral tuberosity fracture:a Meta analysis[J]. China Journal of Orthopaedics and Traumatology, 2021, 34(2):180-190. doi:10.12200/j.issn.1003-0034.2021.02.
[21]	桂琦, 张亚奎, 张星火, 等. 关节镜缝合桥技术与微型钢板螺钉内固定治疗肱骨大结节撕脱骨折的疗效比较[J]. 中华创伤骨科杂志, 2019, 21(2):109-115.
	GUI Q, ZHANG Y K, ZHANG X H, et al. Arthroscopic double-row bridging suture versus minimally invasive locking plate system in treatment of avulsion fracture of humeral greater tuberosity[J]. Chinese Journal of Orthopaedic Trauma, 2019, 21(2):109-115. doi:10.3760/cma.j.issn.1671-7600.2019.02.003.
[22]	卞为伟, 唐晓波, 王健, 等. 关节镜下双排锚钉缝线桥固定技术与切开复位钢板内固定术治疗单纯肱骨大结节骨折的疗效比较[J]. 中华创伤骨科杂志, 2020, 22(7):604-609.
	BIAN W W, TANG X B, WANG J, et al. Arthroscopic double-row anchor suture fixation versus open reduction and internal plating in treatment of simple humeral fracture of the greater tuberosity[J]. Chinese Journal of Orthopaedic Trauma, 2020, 22(7):604-609. doi:10.3760/cma.j.cn115530-20200226-00109.
[23]	卞为伟, 唐晓波, 王健, 等. 关节镜下双排锚钉缝线桥技术治疗肱骨大结节骨折[J]. 中华关节外科杂志(电子版), 2020, 14(5):623-626.
	BIAN W W, TANG X B, WANG J, et al. Arthroscopic double-row anchor suture bridge technique in treatment of humeral greater tuberosity fractures[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(5):623-626. doi:10.3877/cma.j.issn.1674-134X.2020.05.018.
[24]	KUAN F C, HSU K L, HONG C K, et al. Biomechanical comparisons of hook plate and screw fixations in split-type greater tuberosity fractures of the humerus[J]. J Shoulder Elbow Surg, 2022, 31(6):1308-1315. doi:10.1016/j.jse.2021.12.023.
[25]	KOKKALIS Z T, PAPANIKOS E, BAVELOU E, et al. Arthroscopic reduction and fixation of greater tuberosity fractures of the humerus[J]. Eur J Orthop Surg Traumatol, 2021, 31(6):1055-1060. doi:10.1007/s00590-020-02835-8.

组别			n	年龄/岁			受伤至手术时间/d			性别
组别			n	年龄/岁			受伤至手术时间/d			男			女
DRA组			22	66.32±7.66			3.13±1.36			13（59.1）			9（40.9）
SRA-BT组			18	64.17±6.34			2.94±1.16			10（55.6）			8（44.4）
t或χ²				0.953			0.469			0.050
组别	术前肱骨大结节位移距离/mm					侧别					Mutch分型
组别	术前肱骨大结节位移距离/mm					左侧		右侧			撕脱型			劈裂型
DRA组	11.35±2.76					10（45.5）		12（55.6）			18（81.8）			4（18.2）
SRA-BT组	11.58±2.63					7（38.9）		11（61.1）			14（77.8）			4（22.2）
t或χ²	0.268					0.170					0.100
组别		肩关节脱位			致伤原因
组别		肩关节脱位			交通性损伤				运动性损伤			跌倒性损伤
DRA组		7（31.8）			13（59.1）				3（13.6）			6（27.3）
SRA-BT组		6（33.3）			10（55.5）				3（16.7）			5（27.8）
χ²		0.010			0.080

组别			n	年龄/岁			受伤至手术时间/d			性别
组别			n	年龄/岁			受伤至手术时间/d			男			女
DRA组			22	66.32±7.66			3.13±1.36			13（59.1）			9（40.9）
SRA-BT组			18	64.17±6.34			2.94±1.16			10（55.6）			8（44.4）
t或χ²				0.953			0.469			0.050
组别	术前肱骨大结节位移距离/mm					侧别					Mutch分型
组别	术前肱骨大结节位移距离/mm					左侧		右侧			撕脱型			劈裂型
DRA组	11.35±2.76					10（45.5）		12（55.6）			18（81.8）			4（18.2）
SRA-BT组	11.58±2.63					7（38.9）		11（61.1）			14（77.8）			4（22.2）
t或χ²	0.268					0.170					0.100
组别		肩关节脱位			致伤原因
组别		肩关节脱位			交通性损伤				运动性损伤			跌倒性损伤
DRA组		7（31.8）			13（59.1）				3（13.6）			6（27.3）
SRA-BT组		6（33.3）			10（55.5）				3（16.7）			5（27.8）
χ²		0.010			0.080

组别	n	切口长度/cm	手术时间/min	术中出血量/mL	住院时间/d	住院总费用/万元	骨折愈合时间/周	术后肱骨大结节位移距离/mm	术后恢复日常生活时间/d
DRA组	22	5.02±1.07	52.50±13.00	57.77±18.28	10.18±2.70	3.51±0.17	10.85±1.28	3.12±1.05	88.05±16.93
SRA-BT组	18	5.92±1.14	58.39±10.17	66.56±17.17	9.11±2.54	2.10±0.20	10.13±1.42	2.93±1.18	83.50±9.57
t		2.570^＊	1.568	1.554	1.280	24.165^＊＊	1.685	0.539	1.069

组别	n	切口长度/cm	手术时间/min	术中出血量/mL	住院时间/d	住院总费用/万元	骨折愈合时间/周	术后肱骨大结节位移距离/mm	术后恢复日常生活时间/d
DRA组	22	5.02±1.07	52.50±13.00	57.77±18.28	10.18±2.70	3.51±0.17	10.85±1.28	3.12±1.05	88.05±16.93
SRA-BT组	18	5.92±1.14	58.39±10.17	66.56±17.17	9.11±2.54	2.10±0.20	10.13±1.42	2.93±1.18	83.50±9.57
t		2.570^＊	1.568	1.554	1.280	24.165^＊＊	1.685	0.539	1.069

组别	n	静息VAS			活动VAS			ASES
组别	n	术前	术后	t	术前	术后	t	术前	术后	t
DRA组	22	7.72±1.64	1.59±0.67	16.230^＊＊	8.50±1.37	2.41±0.73	18.401^＊＊	23.86±9.63	77.95±9.84	18.427^＊＊
SRA-BT组	18	7.28±1.41	1.27±0.67	16.334^＊＊	8.39±1.33	2.22±0.65	17.683^＊＊	24.72±7.95	80.56±8.20	20.743^＊＊
t		0.898	1.503		0.256	0.860		0.303	0.898

单排锚钉联合骨隧道与双排锚钉治疗肱骨大结节骨折的临床研究

A clinical analysis of single row anchor combined with bone tunnel and double row anchor in the treatment of humerus greater tuberosity fracture

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 6

参考文献 25

相关文章 5

编辑推荐

Metrics

本文评价

组别	n		前屈		外展
DRA组	22		145.05±18.16		135.77±21.34
SRA-BT组	18		147.94±15.89		137.17±18.83
t			0.529		0.217
组别		0°外旋		90°内旋
DRA组		32.82±11.73		47.23±11.99
SRA-BT组		34.56±12.38		48.72±8.37
t		0.455		0.445

[1]	方晓辉, 袁晓庆, 吴一雄, 李桂军, 高立波, 胡辉东, 高磊. 关节镜下单胫骨隧道技术治疗前交叉韧带胫骨止点撕脱性骨折的近期疗效#br#[J]. 天津医药, 2020, 48(12): 1218-1222.
[2]	郭志涛. 肱骨干骨折合并肱动脉栓塞一例报告[J]. , 2013, 41(2): 191-191 .
[3]	曹红彬1 ,辛景义2 ,梁军3 ,李秀兰4 ,于顺禄3 . 骨髓基质细胞对移植肌腱在骨隧道内愈合作用的组织学研究[J]. , 2012, 40(9): 923-925 .
[4]	李泽芹. 肱骨远端骨折术后急性肘关节化脓性感染一例报告[J]. , 2010, 38(8): 0-0 .
[5]	韩岳. 节段性大段异体骨髓移植治疗肱骨干肿瘤[J]. , 2010, 38(7): 618-619 .