Implantation of plate and hollow screw for the repair of the split fracture of greater tuberosity of humerus: comparison of shoulder joint function

doi:10.3969/j.issn.2095-4344.2014.40.015

Abstract

Abstract:

BACKGROUND: Canada Montreal Scholar Mutch et al have recently proposed a new morphologic classification of fracture of greater tuberosity of humerus. They divided these fractures into three types: avulsion, split and depression.

OBJECTIVE: To compare the recovery of shoulder function after conventional plate-screw and hollow-screw fixation for the repair of the split fracture of greater tuberosity of humerus.

METHODS: Patients with greater tuberosity of humerus, who were treated in the Department of Orthopedics of Yichang Yiling Hospital, China from January 2010 to January 2014, were classified according to Mutch’s classification. A total of 83 patients with split greater tuberosity of humerus after complete follow-up were retrospectively analyzed. Of them, 23 cases received plate-screw fixation as plate-screw group, and 60 cases received hollow-screw fixation as hollow-screw group. Visual Analog Scale, the United States Scores of Shoulder and Elbow Surgeons, and Constant and Murley Scoring Systems were utilized to assess the therapeutic outcomes. Patient’s pain and changes in shoulder function were analyzed before and after treatment.

RESULTS AND CONCLUSION: A total of 83 patients were followed up. Fixator was obtained at 1 year after surgery in all patients. No significant difference in Visual Analog Scale, the United States Scores of Shoulder and Elbow Surgeons, and Constant and Murley Scoring Systems was detected in both groups before treatment (P > 0.05). Significant differences in Visual Analog Scale, the United States Scores of Shoulder and Elbow Surgeons, and Constant and Murley Scoring Systems were detectable in both groups at 16 months after removal of the fixator (P < 0.05). Data were better in the hollow-screw group than in the plate-screw group. Above results suggested that hollow-screw fixation in the repair of split fracture of greater tuberosite of humerus is simple to be operated, with small trauma, and is an ideal fixation method. Clinical repair effect is better than plate-screw fixation.

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

全文链接：

Key words: humeral fractures, internal fixators, follow-up studies, pain measurement

CLC Number:

R318

Wang Guang-yong, Du Jun-sheng, Zhong Bing. Implantation of plate and hollow screw for the repair of the split fracture of greater tuberosity of humerus: comparison of shoulder joint function [J]. Chinese Journal of Tissue Engineering Research, 2014, 18(40): 6482-6487.

Figures/Tables 4

2.3 随访结果两组患者随访12-36个月，所有患者均1年取出内固定物。钢板螺钉组23例病例，均于受伤后2周进行随访，劈裂型肱骨大结节骨折均采用经三角肌入路，其中16例仅仅使用普通钢板固定，此16个病例中探查后未发现肩袖损伤，7例患者存在肩袖损伤的情况，其中5例加用可吸收缝合线术中一期行肩袖损伤修复，并固定于钢板的缝合孔上，2例患者钢板内固定后出现肱骨大结节骨新骨折片并伴有移位，这2例患者从2周开始适量的、简单的肩关节功能锻炼时便出现肩关节外旋、外展功能活动受限和行患侧肩关节拍片后，出现肩关节外侧间隙明显减少，并出现肩关节上抬活动时发生撞击综合征，此2例患者早期(2周左右)1例使用铆钉行肩袖损伤二期修复手术，1例使用可吸收缝线行肩袖损伤二期修复手术，但术后该组患者中有2例出现肩部疼痛不适、异物感明显的并发症。空心螺钉组的60例病例，均于受伤后2周进行随访，劈裂型肱骨大结节骨折均采用经三角肌入路，其中35例使用2枚空心螺钉结合垫圈内固定，21例使用3枚空心螺钉结合垫圈内固定，4例患者使用4枚空心螺钉内固定，在使用空心螺钉内固定的方式中，该组患者中有45例探查后发现不存在肩袖损伤情况，15例患者存在肩袖损伤，其中12例使用可吸收线钻孔后固定大结节处，3例患者使用铆钉固定以修复肩袖损伤，治疗后60例患者均未出现肱骨大结节劈裂型骨折的骨折块再次移位、肩袖损伤复发、肩关节撞击综合征等并发症，治疗后取出内固定亦无复发病例。 2组病例分别在治疗前、治疗后采用目测类比评分、美国肩肘外科医师评分、Constant and Murley评分系统进行疗效评定，比较治疗前、治疗后患者的疼痛及肩关节功能变化。采用SPSS 10.0软件对最终评分结果进行t 检验分析，见表2。 2.4 典型病例钢板螺钉组典型病例：女性患者，58岁，因摔伤致右肩部疼痛、活动受限1 d入院，X射线片示：右肱骨大结节劈裂型骨折。行完善的术前准备及相关检查后，达到手术标准后行切开复位钢板置入内固定。可见内固定状态良好；从2周开始适量的、简单的肩关节功能锻炼时便出现肩关节外旋、外展功能活动受限和行患侧肩关节拍片后，出现未完全压住的骨碎片再次移位，并出现肩关节上抬活动时发生撞击综合征，此患者明确诊断后使用可吸收缝线行肩袖损伤二期修复手术，治疗后无复发。骨折愈合后取出内固定钢板及普通螺钉，治疗后亦无复发，治疗后12个月左右取出内固定钢板及螺钉(图1)。空心螺钉组典型病例：患者男性，60岁，因车祸致右肩部疼痛、活动受限1 h入院，X射线片示：右肱骨大结节劈裂型骨折，行完善的术前准备及相关检查后，达到手术标准后行切开复位空心钉置入内固定。治疗后三角巾悬吊固定2周，2周后开始肩关节适当的、简单的功能锻炼，满3周后方进行常规的肩关节功能锻炼，患者中手术切口Ⅰ/甲级愈合。4周后可进行日常活动。6-8周后肩关节可自主活动，治疗后12个月左右取出空心螺钉(图2)。 2.5 不良事件两组患者中均无内固定失败的病例。"

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