肩关节镜下双排锚钉缝线桥技术治疗肱骨大结节撕脱骨折的疗效分析

Shoulder arthroscopic treatment of avulsion fracture of humeral greater tuberosity with double-row suture bridge

目的探讨肩关节镜下双排锚钉缝线桥技术治疗肱骨大结节撕脱骨折的疗效。方法回顾性分析2018年3月至2020年3月广州市荔湾区骨伤科医院骨关节科采用肩关节镜缝线桥技术治疗的13例肱骨大结节撕脱骨折患者资料。男6例,女7例;年龄35~69岁,平均52.3岁。肱骨大结节骨折按照Mutch分型均属于撕脱型。单纯大结节撕脱骨折3例,合并肩关节前脱位10例,均已术前手法复位。陈旧性大结节撕脱骨折3例。术后定期门诊随访并进行X线检查,末次随访时采用疼痛视觉模拟评分(VAS)、美国肩肘外科协会(ASES)肩指数评分、韩国肩关节评分(KSS)评价肩关节疼痛程度、活动度及稳定性。结果所有患者术后获10~16个月(平均12.3个月)随访,术后所有患者均无感染或肩关节不稳。末次随访时外展上举平均164.6°(135°~180°);体侧外旋平均62.7°(40°~80°);内旋摸背试验平均T10水平(L2至T6);VAS平均0.65分(0~2.5分);ASES评分平均90.5分(78~100分);KSS平均91.5分(84~100分)。结论肩关节镜下双排锚钉缝线桥技术治疗肱骨大结节撕脱骨折,手术创伤小,可修复合并损伤,术后恢复快。

Objective To evaluate the shoulder arthroscopic treatment of avulsion fracture of humeral greater tuberosity with double-row suture bridge.Methods Retrospectively analyzed were the 13 avulsion fractures of humeral greater tuberosity which had been treated by shoulder arthroscopic double-row suture bridge at Bone and Joint Department,Guangzhou Liwan District Orthopedic Hospital from March,2018 to March,2020.There were 6 males and 7 females,with an average ages of 52.3 years(from 35 to 69 years).According to the Mutch classification,all the fractures of humeral greater tuberosity were attributed to the avulsion type.Of them,3 were simple avulsion fractures of humeral greater tuberosity and 10 were complicated with shoulder anterior dislocation which was reduced manually before operation.There were 3 obsolete avulsion fractures of humeral greater tuberosity.Regular clinic and X-ray follow-ups were carried out.At the final follow-up,the pain,range of motion(ROM)and stability of the shoulder joint were assessed using visual analogue scale(VAS),American shoulder elbow scores(ASES),and Korean shoulder scores(KSS).Results All the patients were followed up for an average of 12.3 months(from 10 to 16 months)postoperatively.No infection or shoulder instability was observed.At the final follow-up,the abduction and elevation averaged 164.6°(from 135°to 180°),the lateral external rotation 62.7°(from 40°to 80°),the internal rotation touch back test T10 level(from L2 to T6),the VAS 0.65(from 0 to 2.5),the ASES 90.5(from 78 to 100),and the KSS 91.5(from 84 to 100).Conclusion Shoulder arthroscopic treatment of avulsion fracture of humeral greater tuberosity with double-row suture bridge is minimally invasive and allows for repair of combined injury,leading to quick postoperative recovery.