Hünnebeck Sophia M, Magosch Petra, Habermeyer Peter, Loew Markus, Lichtenberg Sven
Abteilung für Obere Extremität, Hand- und Mikrochirurgie, Immanuel Krankenhaus Berlin, Königstraße 63, 14109 Berlin, Germany.
German Joint Center Heidelberg, ATOS Clinic Heidelberg, Bismarckstraße 9-15, 69115 Heidelberg, Germany.
Obere Extrem. 2017;12(3):165-170. doi: 10.1007/s11678-017-0415-3. Epub 2017 Jun 29.
An increasing number of young patients are diagnosed with chondral lesions. Minimally invasive surgical techniques are important in order to delay progression of the early stages of osteoarthritis and the need for total joint replacement.
Patients ( = 32) who had received microfracturing of the shoulder were retrospectively enrolled, of whom 5 had received shoulder replacements after a mean time of 47 months. Of these patients, 23 completed the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley Scores in addition to an additional subjective questionnaire. Patients were then clinically examined and received x‑ray analysis of the operated shoulder. Data from an additional 4 patients were acquired by telephone interview.
Mean follow-up was 105 months. Of the included patients, 13/27 patients reported no pain, 12/27 patients moderate pain. Of these 12, 6/27 reported pain only at night and 3/27 only during rest. Concerning the outcome of surgery, 19/27 patients were "satisfied" or "very satisfied". There was a statistically significant increase in internal rotation, but no further differences in the range of motion pre- and postoperatively. Patients without any signs of osteoarthritis before surgery showed statistically significantly better outcomes. There was a statistically significant increase in radiological signs of osteoarthrosis in pre- versus postoperative patients. Patients with bipolar lesions showed statistically significantly poorer Subjective Shoulder Value (SSV) results.
Even though microfracturing does not prevent radiographic progression, microfracture of the glenohumeral joint might be worth considering as part of a treatment regimen for younger patients who may not yet be treated with arthroplasty.
越来越多的年轻患者被诊断出患有软骨损伤。为了延缓骨关节炎早期的进展以及减少全关节置换的需求，微创外科技术至关重要。
回顾性纳入接受肩部微骨折手术的患者（n = 32），其中5例在平均47个月后接受了肩部置换。这些患者中，23例除完成一份额外的主观问卷外，还完成了上肢、肩部和手部功能障碍（DASH）评分及Constant-Murley评分。然后对患者进行临床检查，并对手术肩部进行X线分析。另外4例患者的数据通过电话访谈获取。
平均随访时间为105个月。在纳入的患者中，13/27的患者报告无疼痛，12/27的患者有中度疼痛。在这12例患者中，6/27报告仅在夜间疼痛，3/27仅在休息时疼痛。关于手术结果，19/27的患者“满意”或“非常满意”。内旋有统计学意义的增加，但术前和术后的活动范围没有进一步差异。术前无骨关节炎迹象的患者显示出统计学上显著更好的结果。术前和术后患者的骨关节炎放射学征象有统计学意义的增加。双极损伤的患者主观肩部值（SSV）结果在统计学上显著较差。
尽管微骨折不能阻止影像学进展，但对于可能尚未接受关节置换术治疗的年轻患者，盂肱关节微骨折可能值得作为治疗方案的一部分加以考虑。
