缝合锚钉在治疗粉碎性肱骨大结节骨折的临床应用

A primary clinic follow-up study on the treatment with suture anchor fixation for comminuted two-part fractures of greater tuberosity

目的探讨有限切开应用缝合锚钉治疗粉碎性肱骨大结节骨折的初期临床疗效。方法 2007年11月至2009年11月,本组有限切开应用缝合锚钉治疗粉碎性肱骨大结节骨折16例,男9例,女7例,年龄42～73岁,平均58.7岁。根据Neer分型,均为Ⅱ部分大结节骨折,骨折块至少三块,其中新鲜骨折10例,陈旧骨折4例,2例翻修;经肩关节外侧切口做有限切开,较大的骨折块用Herbert或中空螺钉固定,粉碎者在解剖颈骨折处拧入5.0mm锚钉,用其缝线经肩袖肌腱缝合固定。末次随访时采用美国肩肘外科医师(ASES)评分,Constant-Murley评分标准进行评分。结果 16例患者获得术后平均11.2个月(7～16个月)随访,X线片显示骨折对位满意,所有患者骨折均愈合,平均愈合时间8.6周(6～12周)。根据ASES及ConstantMurley肩关节评分系统,本组患者的ASES评分平均95.4分(82～100分),Constant-Murley评分平均96.2分(84～100分);肩关节功能:前屈上举平均167°(100°～180°);体侧外旋平均60.5°(40°～90°),内旋手指尖可到达T7-T8(T12-T5)棘突水平。本组未出现内固定失效、骨折移位和腋神经损伤等并发症。结论应用缝合锚钉是治疗用常规方法无法固定的粉碎性肱骨大结节骨折的一种安全有效方法。

Objective To evaluate the clinical outcomes of comminuted two-part fractures of greater tuberosity treated with suture anchor fixation. Methods From November 2007 to November 2009,16 cases with comminuted two-part fractures of greater tuberosity were treated by suture anchor fixation through mini-open approach. There were nine men and seven women, with a mean age of 58.7 years, ranging from 42 years to 73 years. According to Neer classification, all cases were two-part fractures of greater tuberosity with more than three fragments, including 10 acute cases, four old cases and two revision cases. The procedure included open reduction, using cannulated screws or Herbert screws to fix bigger fragment and suture anchor to fix comminuted fragments through rotator cuff tendon. Functional assessment was carried out by using the American Shoulder and Elbow Surgeons （ASES）, and Constant-Murley shoulder outcome score. Results The patients were followed up for an average of 11.2 months （range, 7-16 months）. The X-ray examination showed all fractures healed six to 12 weeks after operation （average 8.6 weeks）. The mean ASES score was 95.4 （range, 82 to 100 points）, and Constant-Murley score was 96.2 points （range, 84 to 100 points）. The forward flexion of the shoulder was 167° in average （range, 100° to 180°）; external rotation was 60.5° （range, 40° to 90°）, and internal rotation of the finger could reach T7 to T8 level （T12-T5）. There was no hardware failure, re-displacement of the fracture or axillary nerve injury.Conclusions Application of suture anchor is an effective and safe method to treat comminuted two-part fractures of greater tuberosity which can not be fixed with conventional methods.