目的 介绍三角肌入路下使用铆钉及可吸收螺钉治疗肱骨大结节移位骨折的经验及技术要点,并评估临床疗效。方法 2017年3月—2018年12月,采用三角肌入路下使用铆钉及可吸收螺钉治疗16例肱骨大结节移位骨折。患者中男5例,女11例,年龄35~77岁,平均（61.7±13.3）岁。所有患者术前均摄肩关节X线片和CT检查,大结节移位超过5 mm视为手术指征。受伤至手术的平均时间为3 d。术后1周开始功能锻炼,每4~6周门诊复查X线,随访6个月时使用Constant-Murley评分和和Dash评分评估患者术后肩关节功能。结果 所有患者获得3~10个月随访,平均（6.9±2.2）个月。截止最后一次随访,16例患者骨折均达到骨性愈合,未有出现骨不连、切口感染、肩袖撕裂、或铆钉松动、退出等并发症。肩关节功能恢复良好,Constant-Murley评分平均（89.3±6.05）分,Dash评分（5.4±3.1）分。结论 三角肌入路下使用可吸收螺钉及可吸收铆钉治疗肱骨大结节骨折治疗效果确切,可吸收材料固定可避免二次手术,具有经济性好、创伤小等优点,可作为治疗肱骨大结节骨折的可选择手术方法。
Objective To introduce the experience and technical key points of using suture anchors and absorbable screws in the treatment of displaced greater tuberosity fractures of the humerus through the deltoid approach, and to evaluate the clinical efficacy. Methods From March 2017 to December 2018, 16 patients with displaced greater tuberosity fractures of the humerus were treated with suture anchors and absorbable screws through the deltoid approach. There were 5 males and 11 females with an average age of （61.7±13.3） years. All patients underwent shoulder X-ray and CT examinations before operation, and the greater tuberosity fracture displaced more than 5 mm was considered as a surgical indication. The average time from injury to surgery was 3 d. Functional exercise was started 1 week after surgery. The X-ray films were reexamined every 4-6 weeks, and the shoulder function was evaluated using the Constant-Murley score and the Dash score at follow-up visits 6 months later. Results All patients were followed up for 3-10 months, average （6.9 ± 2.2） months. As of the last follow-up, all of the 16 patients showed bone union, and there were no complications such as nonunion, wound infection, rotator cuff tear, or suture anchors loosening and withdrawal. The shoulder function recovered well, with a Constant-Murley score of 89.3±6.05 and a Dash score of 5.4±3.1 on average. Conclusion It is effective to use suture anchors and absorbable screws to treat large tuberosity fractures of the humerus through the deltoid approach. The economic absorbing materials can prevent secondary surgery and produce small trauma. The method is a good choice for the treatment of large tuberosity fractures of the humerus.
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