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肩关节镜下关节融合术：十四年随访

Arthroscopic arthrodesis of the shoulder: Fourteen-year follow-up.

作者信息

Jiménez-Martín Antonio, Pérez-Hidalgo Santiago

机构信息

Department of Orthopaedic Surgery, Hospital FREMAP Sevilla, Spain.

出版信息

Int J Shoulder Surg. 2011 Apr;5(2):54-9. doi: 10.4103/0973-6042.83199.

DOI:10.4103/0973-6042.83199
PMID:21897586
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3157100/
Abstract

Shoulder arthrodesis is indicated in infections, brachial paralysis, irreparable rotator cuff tears, osteoarthritis without indication of prosthesis, rescue after arthroplasty, or after surgery for cancer. Arthroscopic arthrodesis is exceptional. Our aim is presenting our result after 14 years of follow-up of one patient. We present a case report of a 17-year-old male patient. He suffered fracture of left scapula (type V, Ideberg), fracture of left clavicle (type I, Craig), and fracture of left distal ulna. We realized osteosynthesis of clavicle (plate and screws) with the aim of treating this floating shoulder. Electromyography showed partial axonotmesis of axilar nerve. After 7 months of follow-up, axonotmesis was still present. We realized arthroscopic shoulder arthrodesis (three cannulated screws). Fourteen years later, shoulder movement was as follows: Flexion, 0-90°; maximum abduction, 40° with shoulder atrophy; Constant, 47 points; and UCLA, 17 points, without pain. Arthrodesis with screws reaches a subjective benefit in 82% of patients. Percentage of pseudarthrosis is less than in patients treated with plates, although the risks of infections, fractures, and material removal are greater than in patients treated with plates. Shoulder arthroscopic arthrodesis is exceptional, but it allows minimal surgical aggression.

摘要

肩关节融合术适用于感染、臂丛神经麻痹、不可修复的肩袖撕裂、无假体植入指征的骨关节炎、关节置换术后的挽救治疗或癌症手术后。关节镜下肩关节融合术较为罕见。我们的目的是报告对一名患者进行14年随访后的结果。我们报告一例17岁男性患者的病例。他左侧肩胛骨骨折（V型，Ideberg分型）、左侧锁骨骨折（I型，Craig分型）以及左侧尺骨远端骨折。为治疗该浮动肩，我们对锁骨进行了钢板螺钉内固定。肌电图显示腋神经部分轴索断裂。随访7个月后，轴索断裂仍然存在。我们实施了关节镜下肩关节融合术（三枚空心螺钉）。14年后，肩部活动情况如下：前屈0 - 90°；最大外展40°，伴有肩部萎缩；Constant评分47分；UCLA评分17分，无疼痛。螺钉固定的肩关节融合术在82%的患者中获得了主观上的益处。假关节形成的百分比低于钢板治疗的患者，尽管感染、骨折和取出内固定材料的风险高于钢板治疗的患者。关节镜下肩关节融合术较为罕见，但它能使手术创伤最小化。

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