肱二头肌长头腱切断再固定治疗肱骨近端骨折的病例对照研究

目的:探讨切开复位内固定治疗肱骨近端骨折中采用肱二头肌长头腱切断再固定的临床疗效。方法 :自2014年1月至2017年1月采用切开复位内固定治疗肱骨近端骨折患者50例,根据术中是否采用肱二头肌长头腱切断再固定分为治疗组和对照组,每组25例。治疗组男15例,女10例,年龄(74.1±5.4)岁,在对照组的基础上对肱二头肌长头腱进行切断再固定。对照组男13例,女12例,年龄(73.8±4.5)岁,采用常规的切开复位内固定治疗方法。比较两组患者骨折愈合时间及术后并发症情况,采用VAS评分评价疼痛缓解程度,分别于术后1、3、6、12个月采用肩关节Neer功能评分进行临床疗效评价。结果:50例患者均获得随访,时间12～24(14.5±3.6)个月,两组随访时间比较差异无统计学意义(P0.05);术后1个月治疗组肩关节脱位3例,对照组肩关节脱位9例,两组比较差异有统计学意义(P0.05)。术后1周治疗组与对照组VAS评分分别为2.92±1.10、5.88±0.90,差异有统计学意义(P0.05)。术后1个月治疗组与对照组Neer评分分别为77.88±5.70、73.68±4.90;术后3个月分别为85.88±5.30、79.88±3.90,两组比较差异有统计学意义(P0.05);两组术后6、12个月Neer评分比较差异无统计学意义(P0.05);术后12个月根据Neer评分,治疗组优9例,良14例,差2例;对照组优4例,良18例,差3例;两组比较差异无统计学意义。两组患者骨折愈合时间比较差异无统计学意义,术后未出现并发症。结论:切开复位内固定治疗肱骨近端骨折中采用肱二头肌长头腱切断再固定的方法有利于减少患者疼痛,加快肩关节功能早期恢复,值得临床进一步推广。

Case-control study on long head of biceps tendon cut-off and re-fixation for the treatment of proximal humeral fractures

Objective:To investigate clinical effect of open reduction and internal fixation in treating proximal humeral fracture by using long head of biceps tendon cutted-off and re-fixation.Methods:From January 2014 to January 2017,50 patients with proximal humeral fractures were treated by open reduction and internal fixation. According to whether long head of biceps tendon cutted-off and re-fixation,patients were divided into control group and treatment group,25 patients in each group. There were 13 males and 12 females with an average of (73.8±4.5) years old in control group,treated with conventional open reduction and internal fixation. There were 15 males and 10 females,with an average of (74.1±5.4) years old in treatment group,treated by using long head of biceps tendon cutted-off and re-fixation on the basis of control group. Fracture healing time and complications after operation were compared between two groups,VAS score was used to evaluate relieve degree of pain,and Neer functional score at 1,3,6,12 months after operation was applied to access clinical efficacy.Results:All patients were followed up for 12 to 24 months with an average of (14.5±3.6) months. There was no statistical difference in following-up between tow groups. Postoperative VAS score at 1 week between treatment group and control group were 2.92±1.10 and 5.88±0.90 respectively,and had significant difference(P<0.05). Postoperative Neer functional scores at 1 month between treatment group and control group were 77.88±5.70 and 73.68±4.90 respectively,while 85.88±5.30 and 79.88±3.90 respectively at 3 months after operation,and there were significant difference between two groups at 1 and 3 months after operation(P<0.05). There were no statistical differences in Neer functional score between two groups at 6 and 12 months after operation(P>0.05). According to postoperative Neer score at 12 months,9 patients got excellent results,14 moderate and 2 poor in treatment group;while 4 patients got excellent results,18 moderate and 3 poor in control group;but there was no difference between two groups. Fracture were healed without postoperative complications between two groups.Conclusion:Open reduction internal fixation with in treating proximal humeral fracture by using long head of biceps tendon cutted-off and re-fixation could reduce pain,speed up early recovery of joint function,is worthy of further promotion.