关节镜治疗肩关节脱位合并肱骨大结节骨折近期疗效  

ARTHROSCOPIC ASSISTED TREATMENT OF SHOULDER DISLOCATION COMBINED WITH GREATER TUBEROSITY FRACTURE

作　　者：党育[1] 付中国[1] 芦浩[1] 张培训[1] 张殿英[1] 徐海林[1] 姜保国[1] 

机构地区：[1]北京大学人民医院创伤骨科,北京100044

出　　处：《中国修复重建外科杂志》2009年第3期271-273,共3页Chinese Journal of Reparative and Reconstructive Surgery

基　　金："十一五"国家科技支撑计划资助项目(2007BA104B00)~~

摘　　要：目的探讨关节镜治疗肩关节脱位合并肱骨大结节骨折的手术方法及近期临床效果。方法2006年2月-2008年6月,收治12例肩关节脱位合并肱骨大结节骨折患者。男4例,女8例;年龄34～79岁,平均58.8岁;左、右肩各6例;摔伤11例,钝器砸伤1例。受伤至就诊时间为30min～24h,平均2.1h。X线片检查肱骨大结节骨折移位5～12mm,平均5.8mm,MRI诊断Bankart损伤2例。于急诊手法复位肩关节后3～14d行关节镜检术。镜下诊断Bankart损伤3例,SLAP损伤1例,以钛金属锚钉固定修复;大结节骨折采用空心钉内固定3例,可吸收螺钉固定2例,钛金属锚钉固定7例。3例为关节镜下修复,9例为关节镜辅助小切口修复。结果术后患者切口均Ⅰ期愈合,无感染等相关并发症发生。12例患者均获随访,随访时间6～32个月,平均16个月。患者肩关节稳定,未出现再次脱位。术后6个月随访时3例出现肩关节外展活动轻度受限;1例前屈时疼痛,考虑与肩关节撞击相关。X线片示术后2～6个月肱骨大结节骨折愈合,平均3.2个月。术后6个月根据美国肩肘外科医师评分标准评分为(16.03±1.03)分;美国加州大学洛杉矶分校评分标准评分为(32.65±4.83)分;优8例,良3例,可1例,优良率91.7%。结论肩关节镜下治疗肩关节脱位合并肱骨大结节骨折手术安全、微创,术中诊断全面准确,近期疗效满意,功能恢复好,疼痛缓解明显。Objective To investigate the operative method and clinical results of arthroscopic assisted treatment of shoulder dislocation combined with fracture of greater tuberosity of humerus. Methods From February 2006 to June 2008,12 cases of shoulder dislocation （6 left,6 right） combined with greater tuberosity fractures were treated. There were 4 males and 8 females with an average of 58.5 years （range 34-79 years）. Eleven cases fall down and one was crushed. The time from injury to hospital averaged 2.1 hours （range 30 minutes-24 hours）. X-ray lms revealed greater tuberosity fractures with average 5.8 mm （range 5-12 mm） displacement,and MRI showed Bankart lesion in 2 cases. Arthroscopic examination taken 3-14 days after reduction revealed 3 cases of Bankart lesion and 1 case of SLAP lesion. Three cases of great tuberosity fractures were xed with canulated screws,2 cases with absorbable screws,7 cases with titanium suture anchor. Three cases were repaired under arthroscopy,and 9 cases were repaired under arthroscopic assistance mini-incision. Results All the incisions were healed at rst intention without infection. All patients were followed up for 6-32 months （average 16 months）. The shoulder joints were xed stably without redislocation. Six months after operation,there were 3 cases with mild limitation of abduction and 1 case with pain in exion related with impingement. The X-ray lms showed all fractures healed 2-6 months after operation （average 3.2 months）. The American Shoulder and Elbow Surgeons and University of California at Los Angeles scores were 16.03 ± 1.03 and 32.65 ± 4.83,respectively. Eight cases wereffexcellent,3 were good,1 were fair and theffexcellent and good rate was 91.7%. Conclusion For shoulder dislocation combined with fracture of greater tuberosity of humerus,the treatment by shoulder arthroscopy is a safe and mini-invasive operative method with comprehensively accurate intraoperation diagnosis,satisfying therapeutic effect,good functional recovery,as well as obvious r

关 键 词：肩关节脱位 肱骨大结节骨折 关节镜 

分 类 号：R687.3[医药卫生—骨科学]