肩关节镜下双排锚钉固定技术治疗肱骨大结节撕脱骨折的临床研究

目的:观察肩关节镜下双排锚钉固定技术治疗肱骨大结节撕脱骨折的疗效。方法:对2009年9月至2013年1月行肩关节镜下双排锚钉固定技术治疗的19例肱骨大结节撕脱骨折患者进行了回顾性研究,其中男12例,女7例;平均年龄46.8岁(24~69岁);右肩11例,左肩8例;损伤机制包括交通事故伤10例,运动损伤6例,摔伤3例。从受伤到手术的平均时间为34.9 d(3~72 d)。术后3周内将患肢悬吊固定。术后第2天开始肩关节的摆动练习,3周后取下吊带继续锻炼,6周时进行无痛的主动练习。术后6、12和24周,以及之后的每6个月均在门诊进行复查随访。每次随访时均拍摄肩关节正侧位X线片,在末次随访中,使用量角器测量关节活动度,并进行VAS疼痛评分、美国加州洛杉矶大学(UCLA)功能评分和美国肩肘外科医师(ASES)评分。结果:术后19例均获随访,平均随访时间35.2个月(24~48个月)。所有患者术后切口Ⅰ期愈合,无相关并发症。术后立即以及每次随访时均进行X线检查,所有患者在12周内达到了骨愈合。截止最后1次随访,所有患者未出现继发性肩峰撞击,未发生并发症导致的二次手术,未出现其他的并发症,患者前屈、外展、外旋、内旋的关节活动度提升明显(P值均0.05),UCLA评分由术前的15.2±5.3提高到术后的35.6±6.1(P0.05),ASES评分由术前的31.2±5.4提高到术后的91.2±6.8(P0.05)。结论:关节镜双排缝合锚钉固定可以为肱骨大结节撕脱骨折的治疗提供令人满意的临床结果,是一种微创、有效的方法,尤其对于小的或粉碎性的撕脱骨折效果更佳。应用关节镜双排缝合锚钉固定大结节撕脱骨折对外科医生的技术要求相对较高,术后定期复查,遵循康复方案积极训练的重要性也不可忽视。

Clinical research of treating the avulsed fracture of humerus greater tuberosity using an arthroscopic double-row suture anchor fixation technique

Objective: To evaluate the early clinical effects of treating the avulsed fracture of humerus greater tuberosity using the double-row suture anchor fixation technique.Methods: Total 20 patients with the avulsed fracture of the greater tuberosity of the humerus were treated from September 2009 to January 2013. There were 12 males and 7 females,with an average age of 46.8 years old(24 to 69 years old). Eleven patients had injuries on right shoulder joint and 8 patients had injuries on left side. The injury mechanism included 10 cases of traffic accident,6 cases of sports injury,and 3 cases of falls. The mean interval from injury to surgery was 34.9 d (ranged,3 to 72 d). The affacted arm was suspended and fixed within 3 weeks after operation. The swing exercise of shoulder joint was performed from the 2nd day after operation. The strap was removed 3 weeks after operation,and painless active exercise was performed 6 weeks after operation. The patients were followed up in the outpatient department 6,12 and 24 weeks after operation,and then every 6 months. AP and lateral X-ray films were taken at each follow-up time. At the latest follow-up,protractor was used to measure activity of patients;and VAS pain score,California University of Losangeles(UCLA) standard,American Shoulder and Elbow Surgeons (ASES) score were used to evaluate therapeutic effects.Results: All the patients were followed up,with a mean duration of 35.2 months (ranged,24 to 48 months). All the incisions were healed on the first stage without secondary acromion impingement and other complications. All the patients had bony union within 12 weeks. The movements of shoulder joints including flexion,abduction,external rotation,internal rotation were increased obviously(P<0.05). The UCLA score was increased from preoperative 15.2±5.3 to 35.6±6.1 at the latest follow-up. The ASES score was increased from preoperative 31.2±5.4 to 91.2±6.8 at the latest follow-up (P<0.05).Conclusion: It has satisfactory curative effects for the avulsed fracture of humerus greater tuberosity using the double-row suture anchor fixation technique,especially the cases of small or comminuted fractures. It has several advantages such as firm fixation,simple and secure-operation as well as quick postoperative recovery. Finally,patient should take exercises actively after operations.