关节镜下固定技术治疗粉碎性、移位的大结节骨折。
Arthroscopic fixation technique for comminuted, displaced greater tuberosity fracture.
机构信息
Department of Orthopedic Surgery, College of Medicine, The Catholic University, Daejeon St Mary's Hospital, Daejeon, South Korea.
出版信息
Arthroscopy. 2010 May;26(5):600-9. doi: 10.1016/j.arthro.2009.09.011. Epub 2010 Feb 26.
PURPOSE
The purpose of this retrospective study was to evaluate the early results of arthroscopic treatment in patients with comminuted, displaced greater tuberosity (GT) fractures using the arthroscopic double-row suture anchor fixation (ADSF) technique.
METHODS
Between August 2004 and December 2007, we used the ADSF technique in 16 cases of isolated comminuted, displaced GT fractures. The early clinical results were evaluated in these patients at a mean of 24 months (range, 16 to 51 months) after surgery. There were 11 male and 5 female patients with a mean age of 56.5 years (range, 27 to 82 years). These 16 cases had at least 5 mm of displacement of the fracture fragments in any plane. For measurement of clinical outcomes, we assessed range of motion and evaluated the visual analog scale score; the University of California, Los Angeles (UCLA) rating scale; and the shoulder index of the American Shoulder and Elbow Surgeons.
RESULTS
At final follow-up, the visual analog scale score improved from 9.4 (range, 8 to 10 points) to 1.2 (range, 0 to 4 points), the mean UCLA score improved to 31 points (range, 21 to 35 points) postoperatively, and the American Shoulder and Elbow Surgeons score improved to 88.1 points (range, 81.5 to 100 points). According to the UCLA score, there were 3 excellent results, 11 good results, and 2 poor results. Mean forward flexion was 148.7 degrees (range, 120 degrees to 170 degrees), mean abduction was 145 degrees (range, 120 degrees to 170 degrees), mean external rotation in the neutral position was 24 degrees (range, 10 degrees to 40 degrees), and internal rotation improved to the first lumbar vertebral level (from L3 to T7) at last follow-up.
CONCLUSIONS
The early results of the ADSF technique used for displaced, comminuted GT fractures are encouraging, and arthroscopists should attempt to expand the indications for arthroscopic treatment of these fractures.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
本回顾性研究旨在评估关节镜下双排缝线锚钉固定（ADSF）技术治疗粉碎性、移位性大结节（GT）骨折的早期结果。
方法
2004 年 8 月至 2007 年 12 月，我们使用 ADSF 技术治疗 16 例孤立性粉碎性、移位性 GT 骨折。术后平均 24 个月（16 至 51 个月）对这些患者进行早期临床评估。11 例为男性，5 例为女性，平均年龄 56.5 岁（27 至 82 岁）。这些病例的骨折碎片在任何平面均有至少 5mm 的移位。为了评估临床结果，我们评估了活动范围，并评估了视觉模拟量表评分、加利福尼亚大学洛杉矶分校（UCLA）评分、肩肘外科医师协会（美国）评分。
结果
末次随访时，视觉模拟量表评分从 9.4 分（8 至 10 分）改善至 1.2 分（0 至 4 分），术后 UCLA 评分平均改善至 31 分（21 至 35 分），美国肩肘外科医师协会评分改善至 88.1 分（81.5 至 100 分）。根据 UCLA 评分，3 例为优，11 例为良，2 例为可。平均前屈 148.7°（120°至 170°），平均外展 145°（120°至 170°），中立位外旋 24°（10°至 40°），末次随访时内旋至第 1 腰椎水平（L3 至 T7）。
结论
ADSF 技术治疗移位性、粉碎性 GT 骨折的早期结果令人鼓舞，关节镜医师应尝试扩大关节镜治疗这些骨折的适应证。
证据等级
IV 级，治疗性病例系列。
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