肩关节镜下去除肱骨近端锁定钢板的应用

Preliminary Application of Arthroscopic Removal of Proximal Humeral Locking Plates

目的探讨采用肩关节镜技术去除肱骨近端锁定钢板的临床应用价值。方法回顾性分析2013年9月-2015年12月肱骨近端锁定钢板内固定术后疼痛及活动受限15例资料,男10例,女5例,内固定术后12-24（13.6±4.7）月,年龄29-72（46.3±2.4）岁,左侧4例,右侧11例,均应用标准肩关节镜技术去除肱骨近端锁定钢板。结果 15例均顺利通过肩关节镜取出肱骨近端锁定钢板,12例采用3个切口（近端2个切口长0.5 cm,外下方切口长约2 cm）,3例附加一后方入路（长约0.5 cm）行盂唇清理、肩峰成形及关节囊松解术。手术时间30-90（50.2±4.6）min。术后切口均一期愈合,住院时间3-4 d。术后随访3-12（6.1±1.8）月。Neer评分术前55-85（69.2±8.4）分,术后3个月80-95（93.4±3.3）分,明显提高（t=-13.524,P=0.000）。结论肩关节镜下去除肱骨近端锁定钢板具有切口小、创伤小、切口感染风险低、三角肌干扰小等优势,且肩关节镜能够协助诊治肱骨近端内固定术后肩关节周围及盂肱关节内伴随的病变,值得在临床上推广应用。

Objective To investigate the clinical value of shoulder arthroscopy to remove the locking proximal humeral plate.Methods Between September 2013 and December 2015,15 cases of proximal humeral locking plate fixation,10 males and 5females,were retrospectively analyzed. The time post-operation ranged 12- 24 months（ mean,13. 6 ± 4. 7 months）,and the age ranged 29- 72（ mean,46. 3 ± 2. 4） years old. There were 4 left sided cases and 11 right sided cases. The proximal humeral locking plate was removed by utilizing standard shoulder arthroscopy in all the patients. Results The locking proximal humeral plate was successfully removed by shoulder arthroscopy in all the 15 cases. The operation was performed with 3 incisions in 12 cases（ 2 proximal incisions 0. 5 cm in length and an incision inferior to external arm 2 cm in length）. For acromioplasty and joint capsule lysis,an additional posterior approach about 0. 5 cm in length was required in 3 cases. The operation consumed 30- 90 min（ mean,50. 2 ± 4. 6min）. All the incisions were healed at first intention. The hospitalization time was 3- 4 days. Postoperative follow-up ranged 3- 12months（ mean,6. 1 ± 1. 8 months）. Preoperative Neer scores were 55- 85（ 69. 2 ± 8. 4） points,which were improved to 80- 95（ 93. 4 ± 3. 3） points postoperatively（ t =- 13. 524,P = 0. 000）. Conclusions There are some advantages in removing locking proximal humeral plate by standard shoulder arthroscopy,such as smaller incision,less trauma,lower risk of wound infection,less deltoid disturbance,and so on. Simultaneously,the shoulder arthroscopy can assist in diagnosis and treatment of complications around the shoulder joint and glenohumeral joint after proximal humeral internal fixation. The operation is worthy of clinical application.