关节镜辅助治疗肩关节脱位合并大结节骨折

Dang Yu, Fu Zhongguo, Lu Hao, Zhang Peixun, Zhang Dianying, Xu Hailin, Jiang Baoguo

Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Mar;23(3):271-3.

OBJECTIVE

To investigate the operative method and clinical results of arthroscopic assisted treatment of shoulder dislocation combined with fracture of greater tuberosity of humerus.

METHODS

From February 2006 to June 2008, 12 cases of shoulder dislocation (6 left, 6 right) combined with greater tuberosity fractures were treated. There were 4 males and 8 females with an average of 58.5 years (range 34-79 years). Eleven cases fall down and one was crushed. The time from injury to hospital averaged 2.1 hours (range 30 minutes-24 hours). X-ray films revealed greater tuberosity fractures with average 5.8 mm (range 5-12 mm) displacement, and MRI showed Bankart lesion in 2 cases. Arthroscopic examination taken 3-14 days after reduction revealed 3 cases of Bankart lesion and 1 case of SLAP lesion. Three cases of great tuberosity fractures were fixed with cannulated screws, 2 cases with absorbable screws, 7 cases with titanium suture anchor. Three cases were repaired under arthroscopy, and 9 cases were repaired under arthroscopic assistance mini-incision.

RESULTS

All the incisions were healed at first intention without infection. All patients were followed up for 6-32 months (average 16 months). The shoulder joints were fixed stably without redislocation. Six months after operation, there were 3 cases with mild limitation of abduction and 1 case with pain in flexion related with impingement. The X-ray films showed all fractures healed 2-6 months after operation (average 3.2 months). The American Shoulder and Elbow Surgeons and University of California at Los Angeles scores were 16.03 +/- 1.03 and 32.65 +/- 4.83, respectively. Eight cases were excellent, 3 were good, 1 were fair and the excellent and good rate was 91.7%.

CONCLUSION

For shoulder dislocation combined with fracture of greater tuberosity of humerus, the treatment by shoulder arthroscopy is a safe and mini-invasive operative method with comprehensively accurate intraoperative diagnosis, satisfying therapeutic effect, good functional recovery, as well as obvious relief of pain.

目的

探讨关节镜辅助治疗肩关节脱位合并肱骨大结节骨折的手术方法及临床效果。

方法

2006年2月至2008年6月，治疗12例肩关节脱位（左侧6例，右侧6例）合并大结节骨折患者。其中男性4例，女性8例，平均年龄58.5岁（34 - 79岁）。11例为跌倒致伤，1例为挤压伤。受伤至入院时间平均2.1小时（30分钟 - 24小时）。X线片显示大结节骨折，平均移位5.8 mm（5 - 12 mm），2例MRI显示Bankart损伤。复位后3 - 14天行关节镜检查，发现3例Bankart损伤，1例SLAP损伤。3例大结节骨折用空心螺钉固定，2例用可吸收螺钉固定，7例用钛缝线锚钉固定。3例在关节镜下修复，9例在关节镜辅助小切口下修复。

结果

所有切口均一期愈合，无感染。所有患者随访6 - 32个月（平均16个月）。肩关节固定稳定，无再脱位。术后6个月，3例外展轻度受限，1例屈曲时因撞击疼痛。X线片显示所有骨折术后2 - 6个月愈合（平均3.2个月）。美国肩肘外科医师学会（American Shoulder and Elbow Surgeons）评分及加州大学洛杉矶分校（University of California at Los Angeles）评分分别为16.03±1.03和32.65±4.83。优8例，良3例，可1例，优良率为91.7%。