关节镜十字缝线桥固定肱骨大结节骨折

Arthroscopic cross suture bridge for humeral greater tuberosity fractures

[目的]介绍关节镜十字缝线桥固定大结节骨折的手术技术与初步临床效果。[方法] 2017年07月~2019年11月,本科对16例初次肩关节脱位合并肱骨大结节骨折的患者,进行急诊手法复位,并于复位后2~5日,行关节镜下十字缝线桥技术对肱骨大结节骨折复位固定。男性12例,女性4例,年龄18~40岁,其中,2例合并Slap损伤,4例合并Bankart损伤,均同时以锚钉缝线固定。[结果] 16例患者均顺利手术,无神经损伤,切口均为Ⅰ/甲愈合。随访时间1年,随术后时间推移,16例患者的Constant-Murley评分显著增加(P<0.05)。术后影像检查显示大结节骨块恢复正常解剖位置,至末次随访时,所有患者骨折端均达骨性愈合。[结论]十字缝线桥技术能更好的恢复肱骨大结节的解剖位置,避免外旋、上抬无力及肩峰撞击等并发症。

[Objective]To introduce the surgical technique and primary clinical outcomes of arthroscopic cross suture bridge for humeral greater tuberosity fractures accompanied with primary shoulder dislocation.[Methods]From July 2017 to November 2019,16 patients,including 12 males and 4 females aged 10~40 years,were surgically treated in our department.All the patients received closed reduction of the shoulder dislocation in emergency,and arthroscopic cross suture bridge for reduction and fixation of the greater tuberosity fractures 2~5 days later.Of them,2 patients accompanied with SLAP injuries,while 4 patients accompanied with Bankart injuries,which were repaired simultaneously with anchor suture.[Results]All the patients had operation performed smoothly without nerve injury,and got primary incision healing.As time went during follow-up period more than 12 months,the Constant-Murley score significantly increased in the 16 patients(P<0.05).The postoperative imaging checks revealed that the fractured fragments returned to anatomic position in the greater tuberosity area.To the latest follow up,all patients got bony healing of the fractures.[Conclusion]This arthroscopic cross suture bridge technique does better restore the anatomical position of the humeral greater tuberosity to avoid the weakness of excessive abduction and external rotation,and subacromial impingement.