中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (18): 2863-2868.doi: 10.3969/j.issn.2095-4344.3829

• 骨科植入物 orthopedic implant • 上一篇    下一篇

肱骨近端锁定钢板与空心螺钉固定治疗肱骨大结节MutchⅡ型骨折的差异

刘  刚1,2,3,4,张宝露5,石  杰1,2,3,4,暴丁溯1,2,3,4,曾胜强1,2,3,4,邓  凯1,2,3,4,刘  洋1,2,3,4,汪国友1,2,3,4,扶世杰1,2,3,4   

  1. 西南医科大学附属中医医院,1 骨关节外科,2骨伤疾病研究中心,四川省泸州市   646000;3 泸州市院士工作站,四川省泸州市   646000;4 广东省医学3D打印应用转化工程技术研究中心西南医科大学附属中医医院临床基地,四川省泸州市   646000;5西南医科大学护理学院,四川省泸州市   646000
  • 收稿日期:2020-02-28 修回日期:2020-03-06 接受日期:2020-05-09 出版日期:2021-06-28 发布日期:2021-01-12
  • 通讯作者: 扶世杰,教授,主任医师,西南医科大学附属中医医院,骨关节外科,骨伤疾病研究中心,四川省泸州市 646000;泸州市院士工作站,四川省泸州市 646000;广东省医学3D打印应用转化工程技术研究中心西南医科大学附属中医医院临床基地,四川省泸州市 646000;西南医科大学护理学院,四川省泸州市 646000
  • 作者简介:刘刚,男,1987年生,四川省泸州市人,汉族,2018年西南医科大学毕业,硕士,医师,主要从事肱骨大结节骨折与肩袖损伤方面的研究。
  • 基金资助:
    四川省哲学社会科学重点研究基地现代设计与文化研究项目(MD18E014),项目负责人:刘刚

Difference between proximal humeral locking plate and cannulated screw fixation in the treatment of Mutch type II fracture of greater tuberosity of humerus

Liu Gang1, 2, 3, 4, Zhang Baolu5, Shi Jie1, 2, 3, 4, Bao Dingsu1, 2, 3, 4, Zeng Shengqiang1, 2, 3, 4, Deng Kai1, 2, 3, 4, Liu Yang1, 2, 3, 4, Wang Guoyou1, 2, 3, 4,      Fu Shijie1, 2, 3, 4   

  1. 1Department of Orthopedics, 2Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,  Sichuan Province, China; 3Academician Workstation in Luzhou,  Sichuan Province, China; 4Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology 
  • Received:2020-02-28 Revised:2020-03-06 Accepted:2020-05-09 Online:2021-06-28 Published:2021-01-12
  • Contact: Fu Shijie, Professor, Chief physician, Department of Orthopedics, and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China; Academician Workstation in Luzhou, Luzhou 646000, Sichuan Province, China; Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou 646000, Sichuan Province, China
  • About author:Liu Gang, Master, Physician, Department of Orthopedics, and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China; Academician Workstation in Luzhou, Luzhou 646000, Sichuan Province, China; Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou 646000, Sichuan Province, China
  • Supported by:
    the Modern Design and Cultural Research Project of Sichuan Provincial Key Research Base of Philosophy and Social Sciences, No. MD18E014 (to LG)

摘要:

文题释义:
肱骨近端锁定钢板:是一种带有螺纹孔的骨折固定钢板,这些孔在带有螺纹头的螺钉拧入后,钢板就成为一种(螺钉)角度固定装置。钢板同时具有锁定和非锁定孔,以供不同螺钉拧入,便于临床应用。任何能够拧入角度固定(稳定)的螺钉、栓的钢板实质上都是锁定钢板。
肱骨大结节MutchⅡ型骨折:2014年MUTCH教授将单纯的肱骨大结节骨折分为撕脱、劈裂和压缩骨折3型。MutchⅡ型(劈裂)骨折的骨折块较大而且骨折线较为垂直,这类骨折的损伤机制可能是在发生肩关节脱位或者半脱位时撞击了关节盂的前上部分所致。

背景:近年来,肱骨近端锁定钢板临床应用于肱骨近端骨折取得了良好的疗效,但将其应用于肱骨大结节MutchⅡ型(劈裂)骨折的报道较少。
目的:探讨切开复位肱骨近端锁定钢板内固定治疗肱骨大结节MutchⅡ型(劈裂)骨折的临床疗效。
方法:选择2009年5月至2018年6月西南医科大学附属中医医院收治的MutchⅡ型肱骨大结节患者40例,其中男29例,女11例,依据内固定方式分为2组:观察组接受肱骨近端锁定钢板内固定治疗,对照组接受空心螺钉内固定治疗,每组20例。术后随访骨折愈合与肩关节功能,采用美国肩肘外科医师评分(ASES)、Constant-Murley评分(CMS)、美国加州大学肩关节评分(UCLA)、目测类比评分评估肩关节功能。试验获得西南医科大学附属中医医院伦理委员会批准,伦理号:SWMUTCMJ-2017-09-10。
结果与结论:①术后随访1年,未出现钢板或螺钉松动、折断等并发症,观察组出现1例大结节畸形愈合,1例肩关节疼痛;对照组出现3例大结节畸形愈合,2例大结节上移,2例肩关节疼痛;②术后随访1年时,观察组CMS评分、UCLA评分高于对照组(P < 0.05),两组间ASES评分、目测类比评分比较差异无显著性意义(P > 0.05);③结果表明,肱骨近端锁定钢板内固定治疗肱骨大结节MutchⅡ型骨折能实现坚强固定并恢复大结节骨折的移位,但其并发症仍需重视。
https://orcid.org/0000-0003-0420-6316 (刘刚) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 骨, 固定, 植入物, 肱骨大结节, MutchⅡ型骨折, 钢板, 空心螺钉

Abstract: BACKGROUND: In recent years, proximal humeral locking plate has achieved good results in the treatment of proximal humeral fractures. However, there are few reports of locking plate application in Mutch type II greater tuberosity split fractures.
OBJECTIVE: To exploit the clinical effect of Mutch type II greater tuberosity split fractures of proximal humerus with open reduction and internal fixation with locking plate of proximal humerus. 
METHODS: From May 2009 to June 2018, 40 patients (29 males and 11 females) with Mutch type II GT split fractures were treated in the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. They were randomly divided into two groups. The observation group received internal fixation with locking plate of proximal humerus (n=20). The control group received cannulated screw fixation (n=20). The fracture healing and shoulder joint function were followed up after operation. Shoulder joint function was assessed by American Shoulder and Elbow Surgeon (ASES) score, Constant-Murley score (CMS), University of California, Los Angeles  (UCLA) shoulder score, and visual analogue scale score. The trial was approved by the Ethics Committee of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University (approval No. SWMUTCMJ-2017-09-10). 
RESULTS AND CONCLUSION: (1) After 1 year of follow-up, there were no complications such as plate or screw loosening or broken. In the observation group, there were one case of malunion of large tuberosity and one case of shoulder joint pain. In the control group, there were three cases of malunion of large tuberosity, two cases of upward movement of large tubercle and two cases of shoulder joint pain. (2) At 1-year follow-up, the CMS score and UCLA score of the observation group were higher than those of the control group (P < 0.05). ASES score and VAS score showed no significant difference (P > 0.05). (3) The results showed that proximal humeral locking plate internal fixation in the treatment of Mutch II type fracture of greater tuberosity of humerus can achieve strong fixation and restore the displacement of greater tuberosity fracture. However, we still have to take an eye in complication.

Key words: bone, fixation, implants, greater tuberosity of humerus, Mutch type II fractures, plate, cannulated screw

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