三种手术方法在肩关节脱位合并肱骨大结节撕脱骨折中的应用  

Clinical application of three surgical methods in the treatment of dislocation of shoulder joint combined with fracture of greater tuberosity of humerus

作　　者：徐云钦[1] 李强[1] 申屠刚[1] 王刚[1] 姚有榕[1] 邓盼[1] 罗正理[1] 汤勇[1] 

机构地区：[1]解放军第98医院全军创伤修复中心骨四科,浙江省湖州市313000

出　　处：《中国骨与关节损伤杂志》2012年第3期203-205,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察肩关节脱位并肱骨大结节撕脱骨折三种手术方法的疗效。方法对89例肩关节脱位并肱骨大结节撕脱骨折分别采用传统肩前三角肌和胸大肌间隙入路并肱骨近端解剖型钢板螺钉内固定、肩前外侧经三角肌入路并可吸收螺钉内固定、肩前外侧经三角肌入路并微型钢板螺钉内固定。结果本组获随访13～118个月,上述三种手术方法术后肩关节功能优良率分别为:57.57%、81.08%、84.21%;肩根部周径增加程度:术后第1、3、7天肩前外侧经三角肌入路组肩根部周径增加程度明显小于传统肩前三角肌、胸大肌入路组(P<0.05);肩峰下撞击综合征:以肩前外侧经三角肌入路并可吸收钉及微型钢板螺钉组均明显少于传统经三角肌、胸大肌入路并肱骨近端解剖型钢板螺钉组(P<0.05)。结论肩前外侧经三角肌入路较传统肩前三角肌、胸大肌入路具有创伤小、操作简单的优点;可吸收螺钉及微型钢板螺钉可有效固定肱骨大结节撕脱骨折,并减少肩峰下撞击的并发症;肩关节脱位合并肱骨大结节撕脱骨折应根据肱骨大结节骨折形态、肩关节是否已闭合复位及是否合并肱骨近端其他骨折的情况来选择合适的手术入路与内固定物。Objective To study the value of three surgical methods in the treatment of dislocation of shoulder joint combined with fracture of greater tuberosity of humerus. Methods All of 89 patients with dislocation of shoulder joint combined with fracture of greater tuberosity of humerus were divided into three groups randomly （anteriomedialis of shoulder approach with anatomy plate, antero-lateral approach with absorption nail, antero-lateral approach with mini- plate）. Results All the patients were followed up for 13 to 118 months. The rates of excellent and good function recovery of shoulder joint were 57.57%,81.08% and 84.21%. The circumference of proximal shoulder increased 1, 3, 7 days after operation in antero-lateral approach groups, smaller than that in anteriomedialis of shoulder approach group. Conclusion Antero-lateral approach is believed to be a simple method with less trauma. Absorbable screws and mini-plate can effectively fix fracture of greater tuberosity of humerus, and reduce subacromial impingement syndrome （P 〈0.05）. The suitable surgical approach and internal fixation should be selected according to fracture morphous, whether it is closed reduction of shoulder and whether combined with other fractures.

关 键 词：肩关节 脱位 肱骨大结节 骨折 入路 内固定 

分 类 号：R[医药卫生]