Kim S H, Ha K I
Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Arthroscopy. 2000 Oct;16(7):695-700. doi: 10.1053/jars.2000.9237.
The purpose of this study is to describe arthroscopic findings and the results of arthroscopic treatment of patients with chronic shoulder pain caused by a minimally displaced fracture of the greater tuberosity.
This is a retrospective case series in a consecutive sample of 23 patients with a minimally displaced or nondisplaced fracture of the greater tuberosity who underwent outcome analysis after arthroscopic treatment.
Twenty-three patients with chronic shoulder pain beyond 6 months after fracture of the greater tuberosity underwent arthroscopic treatment and were retrospectively assessed after an average of 29 months (range, 22 to 40 months). There were 18 men and 5 women with the average age of 39 years (range, 24 to 61 years). Fourteen fractures were isolated and 9 were related to acute anterior instability episode. The average displacement of the fracture was 2.3 mm (range, 0 to 4 mm) as shown on anteroposterior view plain radiographs.
At the time of arthroscopy, all patients had partial-thickness rotator cuff tears on the articular surface. The cuff tears were located on the tuberosity fracture area and were an Ellman grade I to II in depth. After arthroscopic debridement or repair of the tear, depending on the condition of the tear itself, as well as subacromial decompression, the UCLA score results were good to excellent in 20 and fair in 3 patients. Nineteen of the patients had returned to the previous level of activities. However, the patients engaged in overhead sports activity had a lower level of return to activity (P =.034).
A partial-thickness rotator cuff tear on the articular surface should be considered in patients with chronic shoulder pain after a minimally displaced fracture of the greater tuberosity. Arthroscopic debridement or repair is an appropriate procedure.
本研究旨在描述关节镜检查结果以及对因大结节轻微移位骨折导致慢性肩痛患者进行关节镜治疗的结果。
这是一项回顾性病例系列研究，对连续23例大结节轻微移位或无移位骨折患者进行关节镜治疗后进行结果分析。
23例大结节骨折后6个月以上仍有慢性肩痛的患者接受了关节镜治疗，并在平均29个月（范围22至40个月）后进行回顾性评估。其中男性18例，女性5例，平均年龄39岁（范围24至61岁）。14例为孤立性骨折，9例与急性前不稳定发作有关。前后位X线平片显示骨折平均移位2.3mm（范围0至4mm）。
关节镜检查时，所有患者关节面均有部分厚度的肩袖撕裂。肩袖撕裂位于结节骨折区域，深度为埃尔曼I至II级。根据撕裂本身的情况，在关节镜下对撕裂进行清创或修复，以及进行肩峰下减压后，20例患者的加州大学洛杉矶分校（UCLA）评分结果为良好至优秀，3例为中等。19例患者恢复到了之前的活动水平。然而，从事过头运动的患者恢复活动的水平较低（P = 0.034）。
大结节轻微移位骨折后出现慢性肩痛的患者应考虑关节面存在部分厚度的肩袖撕裂。关节镜清创或修复是一种合适的治疗方法。
