微创空心钉与切开复位内固定治疗肱骨大结节骨折的效果观察

目的探讨微创空心钉与切开复位钢板内固定治疗肱骨大结节骨折临床疗效和安全性。方法选取解放军第一八〇医院骨二科2009年12月～2012年12月收治的经X线或CT确诊的肱骨大结节骨折患者50例,随机分为两组,观察组25例采用微创空心钉内固定,对照组25例采用切开复位钢板内固定。观察两组患者手术时间、术中出血量以及住院时间的差异,并采用肩关节Neer评分标准评价两组患者随访期间的疗效,观察骨折愈合情况。结果观察组手术时间短、出血少、住院时间短,与对照组比较,差异有统计学意义（P〈0.05）。术后对照组出现切口感染3例（12%）。观察组骨折平均愈合时间为（9.4±1.4）周,对照组为（14.9±1.2）周,两组比较差异有统计学意义（P〈0.05）。观察组优良率为92.0%（23/25）,远高于对照组[56.0%（14/25）],差异有统计学意义（P〈0.05）。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手术操作简便,损伤小,出血少,术后关节评分优良,值得临床推荐。

Effect observation on humeral greater tuberosity fracture by minimally invasive cannulated screw and open reduction and plate fixation

Objective To investigate the clinical efficacy and safety of minimally invasive cannulated screw and open reduction and plate fixation in the treatment of humeral greater tuberosity fracture. Methods 50 patients with greater tuberosity fracture diagnosed by X-ray or CT in the Second Department of Orthopedics in the 180th Hospital of Peo- ple＇s Liberation Army from December 2009 to December 2012 were studied. 50 cases were divided into two groups randomly. 25 cases treated by minimally invasive cannulated screw were as the observation group. The other 25 cases treated by open reduction and plate fixation were as the control group. The length of incision, operation time, intraop- erative blood loss, and hospitalization days were observed. According to Neer grading system, efficacy was evaluated, and fracture healing was observed. Results The observation group had shorter operation time, less blood loss, and shorter hospitalization days than the control group, showing significant differences （P 〈 0.05）. Superficial infection oc- curred in 3 cases （12%） of the control group. The time of fracture healing was （9.4±1.4） weeks in the observation group, and was （14.9±1.2） weeks in the control group, showing significant difference （P 〈 0.05）. The good rate of 92.0% （23/25） in the observation group compared with the good rate of 56.0% （14/25） in the control group, with a sta- tistical difference （P 〈 0.05）. Conclusion Compared with open reduction and plate fixation, minimally invasive cannu- lated screw for greater tuberosity fracture has the advantages of simple operation, less trauma, less blood loss, and good shoulder function recovery, which is worthy of clinical promotion.