肱骨大结节解剖型钢板内固定治疗肩关节前脱位合并肱骨大结节骨折的疗效观察

Clinical observation on treatment of anterior dislocation of shoulder joint combined with fracture of greater tuberosity of humerus with anatomical plate of greater tuberosity of humerus

目的观察肱骨大结节解剖型钢板内固定治疗肩关节前脱位合并肱骨大结节骨折的临床疗效,分析治疗失败的原因及其应对策略。方法回顾性分析自2015-04-2018-01采用肱骨大结节解剖型钢板内固定治疗的51例肩关节前脱位合并肱骨大结节骨折。所有患者肩关节前脱位手法复位成功(足蹬法),复位后肱骨大结节骨折移位≥5 mm,需手术治疗。结果 51例均获得随访,随访时间平均12.3(10~24)个月。43例肱骨大结节骨折达到解剖复位标准,末次随访时肩关节功能Constant-Murley评分为(92.6±4.6)分,其中优39例,良4例。8例肱骨大结节骨折块向近端回缩移位,末次随访时Constant-Murley评分为(62.2±6.2)分,其中可2例,差6例。结论肱骨大结节解剖型钢板内固定治疗肩关节前脱位合并肱骨大结节骨折可取得满意疗效,但仍有出现肱骨大结节骨折块回缩移位而导致治疗失败的可能。为降低手术失败率,需解剖复位肱骨大结节骨折并做减张固定,肩外展位下将肩袖缝合至钢板远端孔中,缩短肩袖力臂,必要时加用锚钉固定肩袖。

Objective To observe the clinical effect of anatomical plate of greater tuberosity of humerus in the treatment of anterior dislocation of shoulder joint combined with fracture of greater tuberosity of humerus, and to analyze the causes of treatment failure and coping strategies. Methods A retrospective analysis of 51 cases of anterior dislocation of shoulder joint with fracture of greater tuberosity of humerus treated with anatomical plate internal fixation from April 2015 to January 2018 was made. Manual reduction of shoulder joint was successful in all patients(foot pedal method), the fracture displacement of greater tuberosity of humerus was ≥5 mm after reduction requires surgical treatment. Results The 51 cases were followed up, the average follow-up time was 12.3(10-24) months. Forty-three cases of fracture of greater tuberosity of humerus met the standard of anatomical reduction, and the Constant-Murley score of shoulder joint was(92.6 ±4.6) at the last follow-up, 39 cases were excellent and 4 cases were good. Eight cases of transposition of the humeral greater tuberosity fracture had the proximal retraction, and the Constant-Murley score of shoulder joint was(62.2 ±6.2) at the last follow-up, 2 cases were fair and 6 cases were poor. Conclusion The treatment of anterior dislocation of shoulder joint combined with fracture of greater tuberosity of humerus with anatomical plate of greater tuberosity of humerus can achieve satisfactory results, however, there is still a possibility that the fracture of greater tuberosity of humerus may be retracted and displaced, leading to treatment failure.To reduce the rate of surgical failure, it is required to perform the anatomical reduction of fracture of greater tuberosity of humerus, and tension reduction and fixation, suture the rotator cuff into the distal hole of the plate under the shoulder abduction position, shorten shoulder cuff arm, and if necessary, fix shoulder cuff with anchor.