关节镜下微创治疗IdebergⅢ、Ⅳ型肩胛骨关节盂骨折

Arthroscopic minimally invasive treatment of Ideberg typeⅢ,Ⅳscapular glenoid fractures

目的探讨关节镜联合空心钉技术微创治疗IdebergⅢ、Ⅳ型肩胛骨关节盂骨折的临床效果。方法回顾性分析自2015-01—2021-01在关节镜下微创治疗的5例IdebergⅢ、Ⅳ型肩胛骨关节盂骨折。采用小骨膜剥离子从前方入路进入骨折端复位,主要是恢复关节面平整,残留分离移位可通过加压完成复位。将肩关节Laterjet手术导向器从Neviaser入路置入,卡于骨折端上方,定位器上导向杆平行关节表面并调整内固定方向,尽量使导向杆垂直于骨折线,导针置入孔位于关节盂边缘下1.0 cm深,置入导针,可在镜下观察到骨折端内导针,测量深度,空心钻沿导针钻孔,置入长度合适、直径为4.5 mm的空心钉加压固定,加压后骨折端紧密对合、关节面平顺。结果本组手术时间60~80 min,平均70 min。5例均获得随访,随访时间6~12月,平均8个月。骨折均获得骨性愈合,骨折平均愈合时间为6个月,无内固定失效。术后1周疼痛VAS评分2.0~3.5分,平均2.8分;肩关节功能Constant评分72.5~89.0分,平均80.8分;肩关节功能ULCA评分20.5~30.5分,平均25.5分。末次随访时疼痛VAS评分0.0~1.0分,平均0.5分;肩关节功能Constant评分91.0~99.5分,平均95.2分;肩关节功能ULCA评分26.0~34.5分,平均30.2分。结论关节镜联合空心钉技术微创治疗IdebergⅢ、Ⅳ型肩胛骨关节盂骨折,具有微创、出血量少、安全性高、感染率低、僵硬率低及康复快等优点,疗效满意。

Objective To explore the clinical effect of minimally invasive treatment of Ideberg typeⅢandⅣscapular glenoid fractures using arthroscopy combined with hollow nail technology.Methods A retrospective analysis was conducted on 5 cas⁃es of Ideberg typeⅢandⅣscapular glenoid fractures treated under arthroscopy from January 2015 to January 2021.A small periosteal elevator was used to enter the fracture end for reduction from the anterior approach,and the main goal was to restore the flatness of the joint surface.Residual separation displacement could be compressed and completely reduced through internal fixation.The shoulder joint Laterjet surgical guide was placed through the Neviaser approach and held above the fracture end.The guide rod on the locator was parallel to the joint surface and direction was adjusted to make the guide rod perpendicular to the fracture line as much as possible.The insertion hole of the guide needle was located 1.0 cm below the edge of the joint pel⁃vis.The guide needle could be observed under the microscope,and the depth could be measured.The hollow drill was drilled along the guide needle,and a suitable length and diameter 4.5 mm hollow nail was placed for compression fixation,after com⁃pression,the fracture end was tightly aligned and the joint surface was smooth.Results The surgery was successfully complet⁃ed,with a duration of 60-80 minutes and an average of 70 minutes.All patients in this group were followed up for 6-12 months,with an average of 8 months.The fractures all achieved bony healing.The average healing time of fractures was 6 months,and there was no internal fixation failure.One week after surgery,the VAS score for pain ranged from 2.0 to 3.5 points,with an aver⁃age of 2.8 points;the Constant score for shoulder joint function ranged from 72.5 to 89.0,with an average of 80.8 points;the UL⁃CA score for shoulder joint function ranged from 20.5 to 30.5,with an average of 25.5 points.At the last follow-up,the pain VAS score was 0.0-1.0 points,with an average of 0.5 points;the Constant score for shoulder joint function ranged from 91.0 to 99.5,with an average of 95.2 points;the ULCA score for shoulder joint function ranged from 26.0 to 34.5 points,with an average of 30.2 points.Conclusion The combination of arthroscopy and hollow nail technology for minimally invasive treatment of Ide⁃bergⅢandⅣtype scapular glenoid fractures has the advantages of minimally invasive treatment,less bleeding,high safety,low infection rate,low stiffness rate,and fast recovery.The therapeutic effect is satisfactory.