Katthagen Jan Christoph, Hennecke Daniel, Jensen Gunnar, Ellwein Alexander, Voigt Christine, Lill Helmut
Department of Trauma and Reconstructive Surgery, Diakoniekrankenhaus Friederikenstift gGmbH, Hannover, Germany.
Department of Trauma and Reconstructive Surgery, Diakoniekrankenhaus Friederikenstift gGmbH, Hannover, Germany.
Arthroscopy. 2014 Sep;30(9):1061-7. doi: 10.1016/j.arthro.2014.04.092. Epub 2014 Jun 14.
The purpose of this study was to determine the outcomes of arthroscopy after proximal humeral plating and the occurrence of concomitant pathology and avascular necrosis.
Forty-five patients (28 women; median age, 58.5 years [range, 30 to 82 years]) underwent arthroscopies of 46 shoulders because of unsatisfactory results after locked plating of proximal humeral fractures. They were prospectively followed up for 3, 12, and 24 months postoperatively. Relevant intra-articular lesions were documented. The patients were assigned to 1 of the following groups: (1) articular screw perforation, (2) subacromial plate impingement, or (3) post-traumatic/postoperative shoulder stiffness. Shoulder range of motion and function as measured with the age- and gender-adjusted Constant-Murley score, as well as the Simple Shoulder Test, were compared among the groups.
Concomitant lesions of the articular cartilage, long head of the biceps tendon, tuberosities, and rotator cuff were found in 34 patients (75%). Two-thirds of patients (n = 31) had a partial or complete 270° capsular release. Of the patients, 84% (n = 38) underwent 3 and 12 months' follow-up and 82% (n = 37) underwent 24 months' follow-up. The active range of abduction (P = .029), flexion (P = .048), and internal rotation (P = .0005) had improved significantly at 24 months' follow-up compared with the preoperative status. The mean adjusted Constant-Murley score of patients with post-traumatic shoulder stiffness (n = 15, 64.2% ± 7.9%) and articular screw perforation (n = 19, 73.3% ± 8.4%) was significantly lower (P = .0089 and P = .042, respectively) than that of patients with subacromial plate impingement (n = 12, 93.4% ± 4.3%).
High rates of relevant articular pathologies and the necessity of capsular release in a majority of patients with unsatisfactory results after locked plating of proximal humeral fractures make arthroscopy a valuable revision tool with promising results in cases of high plate positioning, screw perforation, and postoperative/post-traumatic shoulder stiffness.
Level IV, therapeutic case series.
本研究的目的是确定肱骨近端钢板固定术后关节镜检查的结果以及合并病变和缺血性坏死的发生率。
45例患者（28例女性；中位年龄58.5岁[范围30至82岁]）因肱骨近端骨折锁定钢板固定术后效果不佳接受了46例肩关节的关节镜检查。对他们进行术后3、12和24个月的前瞻性随访。记录相关的关节内病变。患者被分为以下几组之一：（1）关节螺钉穿孔，（2）肩峰下钢板撞击，或（3）创伤后/术后肩关节僵硬。比较各组间采用年龄和性别调整后的Constant-Murley评分以及简易肩关节测试所测量的肩关节活动范围和功能。
34例患者（75%）发现有关节软骨、肱二头肌长头肌腱、结节和肩袖的合并病变。三分之二的患者（n = 31）进行了部分或完全270°的关节囊松解。在这些患者中，84%（n = 38）接受了3个月和12个月的随访，82%（n = 37）接受了24个月的随访。与术前状态相比，在24个月随访时外展（P = .029）、屈曲（P = .048）和内旋（P = .0005）的活动范围有显著改善。创伤后肩关节僵硬患者（n = 15，64.2% ± 7.9%）和关节螺钉穿孔患者（n = 19，73.3% ± 8.4%）的平均调整后Constant-Murley评分显著低于肩峰下钢板撞击患者（n = 12，93.4% ± 4.3%）（分别为P = .0089和P = .042）。
肱骨近端骨折锁定钢板固定术后效果不佳的大多数患者中，相关关节病变的发生率高以及关节囊松解的必要性使得关节镜检查成为一种有价值的翻修工具，在钢板位置过高、螺钉穿孔以及术后/创伤后肩关节僵硬的病例中取得了有前景的结果。
IV级，治疗性病例系列。
