摘要
目的有效地对关节镜下微创Herbert钉内固定与切开复位钢板内固定对肩关节脱位合并肱骨大结节骨折的疗效差异进行评价,同时探讨其临床作用机制,最终为临床研究提供可靠、有效的循证医学证据。方法选取我院2014年1月至2015年6月收住的符合诊断标准的36例肩关节脱位合并肱骨大结节骨折患者,分为关节镜下微创Herbert钉组和切开复位钢板内固定组,分别对两组患者的平均手术时间、术中出血量、住院时间以及骨折愈合时间进行比较;同时对两组治疗后3个月UCLA评分和肩关节疗效进行比较。结果两组患者平均手术时间、术中出血量及住院时间方面关节镜下微创Herbert钉组明显优于切开复位钢板内固定组,差异有统计学意义(P<0.05);骨折愈合时间:关节镜下微创Herbert钉组骨折愈合时间为(9.36±0.64)周;切开复位钢板内固定组的骨折愈合时间为(10.22±0.96)周,经统计学分析,t=-4.481,P=0.000,差异有统计学意义;两组治疗后3个月UCLA评分比较:关节镜下微创Herbert钉的疼痛、肌肉肌力明显优于切开复位钢板内固定组,差异有统计学意义(P<0.05);在日常生活和满意度方面两组差异无统计学意义(P>0.05);总分方面差异具有统计学意义(P<0.05);两组治疗后肩关节疗效比较:治疗后关节镜下微创Herbert钉组优良率77.78%;切开复位钢板内固定组优良率为66.11%,两组优良率经统计学分析χ~2=2.429,P=0.048,差异有统计学意义。结论关节镜下微创Herbert钉治疗肩关节脱位合并肱骨大结节骨折具有诊断明确、操作安全、临床疗效确切以及患者依从性高等优势,是一种治疗肩关节脱位合并肱骨大结节骨折较为理想的微创治疗方案,值得临床应用。
Objective To evaluate difference of the curative effect between arthroscopic mini-incision therapeutics Herbert nails and open reduction with internal fixation （ORIF） with plate for shoulder dislocation combined large tuberosity fracture of the proximal humerus,and to explore the potential mechanism,so as to provide reliable and effective evidence-based medicine for clinical research.Methods A total of 36 patients with shoulder dislocation combined large tuberosity fracture of the proximal humerus who were treated in our hospital from January 2014 to June 2015 were included in our study and were divided into two groups with arthroscopic mini-incision therapeutics Herbert nails and ORIF with plate.We compared the operation time,inoperative blood loss,hospitalization time and fracture healing time between the two groups,as well as the UCLA score and shoulder joint effect after treatment for 3 months.Results The average operation time,inoperative blood loss and hospitalization time of the Herbert nails under arthroscopy group was significantly better than those of the ORIF with plate group （P〈0.05）.Fracture healing time of two groups：The facture healing time of the arthroscopic mini-incision therapeutics Herbert nails under arthroscopy group （9.36±0.64） weeks was shorter than the ORIF with plate group （9.36±0.64） weeks vs （10.22±0.96） weeks;t= -4.481,P〈0.001）.UCLA score after treatment for 3 months of the two groups：The UCLA score for pain and muscle strength of the arthroscopic mini-incision therapeutics Herbert nails group was higher than ORIF with plate group （P〈0.05）.There was no significant difference of UCLA score for daily life and satisfaction between the two groups （P〉0.05）.There was a significant difference of total UCLA score between the two groups （P〈0.05）;Curative effect of shoulder after treatment of the two groups：The excellent/good rate of the arthroscopic mini-incision therapeutics Herbert nails group was higher than the ORIF with plate group （77.78% vs 66.11%;χ^2=2.429,P=0.048）.Conclusion The arthroscopic mini-incision therapeutics Herbert nails operation is an ideal treatment method for shoulder dislocation combined large tuberosity fracture of the proximal humerus which has advantages of a clear diagnosis,safety boperation,good curative effect,and high dependability,and is worthy to promote in clinical.
出处
《实用骨科杂志》
2017年第5期395-399,共5页
Journal of Practical Orthopaedics
基金
延安市科技局项目(2010KS-11)
关键词
肩关节脱位
肱骨大结节骨折
关节镜
微创
Herbert钉
临床疗效
shoulder dislocation
greater tuberosity fractures of the proximal humerus
the arthroscopy
mini-incision, Herbert nails
clinical curative effect
