难复性肩关节脱位伴肱骨大结节骨折的手术治疗  

Surgical treatment of the difficult reduction of shoulder joint dislocation combined with greater tuberosity fracture

作　　者：万永鲜 阳运康 徐丽丽 卓乃强 葛建华 鲁晓波 WAN Yongxian;YANG Yunkang;XU Lili;ZHUO Naiqiang;GUO Jianhua;LU Xiaobo(Department of Orthopedics,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China;Department of Rehabilitation Medicine,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China)

机构地区：[1]西南医科大学附属医院骨与关节外科,四川泸州646000 [2]西南医科大学附属医院康复医学科,四川泸州646000

出　　处：《华西医学》2018年第9期1090-1093,共4页West China Medical Journal

基　　金：四川省科技厅支撑计划资助项目(2014SZ0235)

摘　　要：目的探讨切开复位空心螺钉结合铆钉内固定治疗难复性肩关节脱位伴肱骨大结节骨折的疗效。方法 2011年1月—2014年3月,对15例难复性肩关节脱位伴肱骨大结节骨折的患者行切开复位空心螺钉固定大结节同时铆钉修复损伤的肩袖组织,并随访观察手术效果。其中男9例,女6例;年龄45~77岁,平均63.5岁;致伤原因:摔伤7例,高处坠落伤5例,交通事故伤3例;伤后至入院时间为2 h^5 d,平均1.5 d。肩关节均为初次脱位,脱位类型:前脱位14例,后脱位1例。其中大结节单纯撕脱骨折9例,粉碎性骨折5例,同时合并有大、小结节骨折1例,伴有不全神经损伤症状2例,术中未做探查。结果 14例切口Ⅰ期愈合;1例切口发生浅表感染,经清创术及抗感染后愈合。15例患者均获随访,随访时间6~18个月,平均12.2个月。1例术后1个月肩关节再次脱位,2例大结节缺损吸收。术后1年肩关节功能按照Neer评分系统进行评价,获优9例,良3例,可2例,差1例,优良率80.0%。结论切开复位空心螺钉结合铆钉内固定治疗难复性肩关节脱位伴肱骨大结节骨折疗效确切,术后可获得较满意的肩关节功能。Objective To explore the clinical effect of open reduction and internal fixation with hollow screw fixation in the treatment of difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus. Methods From January 2011 to March 2014, 15 patients with difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus were treated with open reduction and hollow screw fixation.There were 9 males and 6 females, aged from 45 to 77 years with an average of 63.5 years. The causes of injury included7 cases of falls, 5 cases of high falling injury, and 3 cases of traffic accident injury. The injury-to-admission time was2 hours to 5 days with an average of 1.5 days. The shoulder joint was the initial dislocation. The types of dislocation showed 14 cases of anterior dislocation and 1 case of posterior dislocation. There were 9 cases of simple avulsion fracture of greater tuberosity of humerus, 5 cases of comminuted fracture, 1 case of both greater tuberosity of humeru with small tuberosity of humerus fracture, and 2 cases of incomplete nerve injury; no exploration was carried out in operation.Results There were 14 patients with wound healing at first intention; 1 suffered superficial infection of the wound, which healed by anti infection treatment. Fifteen cases were followed up for 6 to 18 months with an average of 12.2 months, with1 case of shoulder joint re-dislocation 1 month after operation, and 2 cases of tuberosity of humerus defect absorption.One year after operation, the shoulder joint function were evaluated according to Neer Scoring System, and the results were excellent in 9 cases, good in 3 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 80.0%.Conclusion The curative effect of open reduction and internal fixation with hollow screw fixation on difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus is remarkable, which can obtain satisfactory shoulder

关 键 词：肩关节 脱位 肱骨大结节 骨折 

分 类 号：R687.3[医药卫生—骨科学]