肩关节镜下双排锚钉固定治疗肩关节前脱位伴肱骨大结节撕脱骨折

Arthroscopic treatment of greater tuberosity avulsion fractures with anterior shoulder dislocation using the double-row suture anchor technique

背景:临床上肱骨大结节撕脱骨折固定方式多种多样,若大结节骨块固定欠佳则会导致作为肩关节力学核心的大结节吸收,出现严重的肩关节功能障碍。目的:探索肩关节镜下双排锚钉固定治疗肩关节前脱位伴肱骨大结节撕脱骨折的疗效。方法:回顾性分析2016年1月至2018年10月于西南医科大学附属中医医院使用肩关节镜下双排锚钉固定治疗肩关节前脱位伴肱骨大结节撕脱骨折患者20例的病历资料,并进行系统肩关节功能锻炼,定期随访进行关节功能评定及疼痛评估;对比患者术前及术后的功能恢复情况。结果与结论:①所有患者切口均Ⅰ期愈合,无感染、锚钉松动、神经损伤等并发症发生;术后随访1年,所有患者均未出现明显的肩峰下撞击;②术后1,3,6,12个月,各时间段之间Constant-Murley评分及美国加州大学肩关节功能评分比较,差异均有显著性意义(P<0.05),各时间点评分均优于前一时间点(P<0.05);③术后1个月,患者的静息、活动目测类比评分均显著低于术前(P<0.05),肱骨大结节骨折上移距离显著小于术前(P<0.05);④术后1年患者的前屈、外展、外旋、内收等肩关节活动度恢复良好;⑤提示肩关节镜下双排缝合锚钉能有效恢复大结节的骨折移位,并实现对肩袖肌腱损伤的良好固定,促进其愈合,并缓解患者疼痛,有利于早期的肩关节功能锻炼。

BACKGROUND:In clinic,there are various fixation methods for greater tuberosity avulsion fractures of the humerus.If the fixation of the greater tubercle is unsatisfactory,it will lead to the absorption of the greater tubercle as the mechanical core of the shoulder joint,resulting in serious shoulder joint dysfunction.OBJECTIVE:To explore the curative effect of the treatment of anterior dislocation of shoulder joint with greater tuberosity avulsion fractures of the humerus by double-row suture anchors under shoulder arthroscope.METHODS:A retrospective study was conducted in 20 patients with anterior dislocation of the shoulder and avulsion fracture of the greater tuberosity of the humerus in Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University who underwent arthroscopic double-row suture anchors from January 2016 to October 2018.After operation,systematic shoulder joint function exercise was performed,and joint function evaluation and pain score were regularly followed up.The functional recovery was compared before and after operation.RESULTS AND CONCLUSION:(1)The incisions of all patients healed in stage I,without complications such as infection,loosening of anchor pin,or nerve injury.After one-year follow-up,there was no significant subacromial impact in all patients.(2)At 1,3,6 and 12 months postoperatively,the Constant-Murley score and the University of California at Los Angeles shoulder rating scale score were significantly different(P<0.05);and the score of each time point was better than that of the previous time point(P<0.05).(3)At 1 month after surgery,the resting and activity visual analogue scale scores were significantly lower than before surgery(P<0.05);the displacement distance of greater tuberosity fracture was significantly less than that before operation(P<0.05).(4)One year after operation,the range of motion of shoulder joint such as flexion,abduction,external rotation and adduction recovered well.(5)It is indicated that arthroscopic double-row suture anchors can effectively restore the displacement of the greater tuberosity fractures,and achieve a good fixation of the rotator cuff tendon injury,promote healing,and relieve patients’pain,which is conductive to early shoulder functional exercise.