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关节镜下经皮倒“8”字缝合法固定孤立性肱骨大结节骨折

Arthroscopic percutaneous inverted mattress suture fixation of isolated greater tuberosity fracture of humerus.

作者信息

Jang Suk-Hwan, Song Han-Eui, Choi Seung-Hyuk

机构信息

1 Department of Orthopedic surgery, Sports Medical Center, Inje University, Seoul Paik Hospital, Seoul, Korea.

出版信息

J Orthop Surg (Hong Kong). 2018 Jan-Apr;26(1):2309499017754108. doi: 10.1177/2309499017754108.

Abstract

OBJECTIVE

The purpose of the study was to evaluate the clinical and radiographic outcomes of treatment in patients with isolated greater tuberosity (GT) fractures of humerus using arthroscopic percutaneous inverted mattress suture fixation technique.

MATERIALS AND METHODS

We attempted to use the arthroscopic percutaneous inverted mattress suture fixation technique in 17 consecutive cases with isolated displaced GT fractures. Fourteen patients were successfully treated without switching to other methods and were available for follow-up at a mean of 22 months (range: 17-38 months) after surgery. For assessment of clinical outcomes, we evaluated the range of motion and the visual analog scale (VAS) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES), and the Korean Shoulder Scale (KSS).

RESULTS

At the final follow-up, the VAS improved to 1.0 points (range: 0-3), the mean ASES score improved to 86.9 points (range: 78.3-100) and the KSS improved to 88.6 points (range: 82-100) postoperatively. Mean union time was 10 weeks. Mean forward flexion was 167.8° (range: 140-180°), mean external rotation in neutral position was 36° (range: 20-70°), and mean internal rotation was at the 12th thoracic level (range: T6-L3) at final follow-up. Three cases were switched to open surgery after attempted arthroscopic technique due to large fragment or osteoporosis.

CONCLUSION

In select cases, the arthroscopic percutaneous inverted mattress suture fixation of GT fracture is a simple and reproducible technique with encouraging early results.

摘要

目的

本研究旨在评估采用关节镜下经皮褥式缝合固定技术治疗孤立性肱骨大结节(GT)骨折患者的临床和影像学结果。

材料与方法

我们尝试对17例连续的孤立性移位GT骨折患者采用关节镜下经皮褥式缝合固定技术。14例患者成功接受治疗,未改用其他方法,术后平均随访22个月(范围:17 - 38个月)。为评估临床结果,我们评估了活动范围、视觉模拟量表(VAS)评分、美国肩肘外科医师学会(ASES)的肩部指数以及韩国肩部量表(KSS)。

结果

在末次随访时,VAS评分术后改善至1.0分(范围:0 - 3),ASES平均评分改善至86.9分(范围:78.3 - 100),KSS改善至88.6分(范围:82 - 100)。平均愈合时间为10周。末次随访时,平均前屈为167.8°(范围:140 - 180°),中立位平均外旋为36°(范围:20 - 70°),平均内旋达胸12水平(范围:胸6 - 腰3)。3例患者因骨折块大或骨质疏松,在尝试关节镜技术后改行开放手术。

结论

在特定病例中,关节镜下经皮褥式缝合固定GT骨折是一种简单且可重复的技术,早期结果令人鼓舞。

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