Maroun Ch, Aliani D, Hass A, Werthel J D, Vidil Anne, Valenti Ph
Paris Shoulder Unit, Clinique Bizet, Paris, France.
Eur J Orthop Surg Traumatol. 2017 Apr;27(3):317-321. doi: 10.1007/s00590-017-1938-4. Epub 2017 Mar 13.
Proximal humerus fractures are common injuries. Locking plates and anterograde medullary nails are the two most common fixation devices used when open reduction and internal fixation (ORIF) is indicated. Complications related to fracture and to hardware are numerous, especially shoulder stiffness. The goal of this study is to report the clinical outcomes of gleno-humeral arthroscopic arthrolysis combined with hardware removal.
A total of 58 patients (25 men, 33 women) with a mean age of 58 years (24-79) were reviewed retrospectively. Forty of them were active workers (5 heavy workers), and 18 were retired. A total of 24 fractures were reported after sport accident, 26 after domestic accident, and 8 after high energy trauma. Thirty-four patients with 3 or 4 part fractures (fracture through the anatomic neck and tuberosities), 20 patients with two part (displaced surgical neck) fracture and 4 cases of fracture of the tuberosities were operated. We combined a gleno-humeral arthrolysis by arthroscopy and a removal of the hardware using the previous incision for the plate or by arthroscopy for the nail.
The average follow-up was 23 months (range 6-60). Pain in Constant Murley score (CS) increased from 7.3 ± 3.8 points preoperatively to 13 ± 2.76 points post-operatively (p < 0.05). CS increased from 36.8 ± 12.25 points to 68.45 ± 15.24 points. Subjective shoulder value (SSV) score increased from 45.8 ± 16.6 to 78.23 ± 14.74. A gain in all active range of motion was reported (forward flexion: 37.6°, abduction: 39.5°, external rotation: 24.3°, internal rotation: from L5-S1 to T12-L1).
Gleno-humeral arthrolysis by arthroscopy combined with hardware removal after proximal humerus ORIF in one step is safe and beneficial for post-traumatic stiffness of the shoulder. It provides significant pain relief and increase of range of motion and allows to treat associated articular pathology.
肱骨近端骨折是常见的损伤。当需要切开复位内固定（ORIF）时，锁定钢板和顺行髓内钉是两种最常用的固定装置。与骨折和内固定相关的并发症众多，尤其是肩关节僵硬。本研究的目的是报告肩关节镜下关节松解术联合内固定取出的临床结果。
回顾性分析58例患者（25例男性，33例女性），平均年龄58岁（24 - 79岁）。其中40例为在职劳动者（5例重体力劳动者），18例为退休人员。运动损伤后报告24例骨折，家庭事故后26例，高能创伤后8例。对34例三部分或四部分骨折（通过解剖颈和结节的骨折）、20例两部分（移位的外科颈）骨折患者和4例结节骨折患者进行了手术。我们通过关节镜进行肩关节松解，并使用先前钢板切口或通过关节镜取出髓内钉的内固定物。
平均随访23个月（范围6 - 60个月）。Constant Murley评分（CS）中的疼痛评分从术前的7.3±3.8分增加到术后的13±2.76分（p < 0.05）。CS从36.8±12.25分增加到68.45±15.24分。主观肩关节评分（SSV）从45.8±16.6分增加到78.23±14.74分。所有活动范围均有增加（前屈：37.6°，外展：39.5°，外旋：24.3°，内旋：从L5 - S1到T-12 - L1）。
肩关节镜下关节松解术联合肱骨近端ORIF术后内固定取出一步法对于创伤后肩关节僵硬是安全且有益的。它能显著减轻疼痛，增加活动范围，并可治疗相关的关节病变。
