肩关节镜下张力带缝合技术治疗肱骨大结节骨折早期疗效分析  

Analysis of early efficacy of tension band suture technique in the treatment of humeral greater tuberosity fracture under shoulder arthroscopy

作　　者：唐诗添[1] 刘刚[1] 石波[1] 李佳琪[1] 谢刚泰[1] 郑立诚[1] Tang Shitian;Liu Gang;Shi Bo;Li Jiaqi;Xie Gangtai;Zheng Licheng(Department of Orthopedics,Mianyang Central Hospital,Mianyang 621000,China)

机构地区：[1]绵阳市中心医院骨科,621000

出　　处：《中华肩肘外科电子杂志》2020年第2期135-139,共5页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：绵阳市科技局项目(2018FYZJ039)。

摘　　要：目的探讨肩关节镜下张力带缝合技术治疗肱骨大结节骨折的临床疗效。方法回顾性分析2015年5月至2017年6月采用肩关节镜下张力带缝合技术治疗15例患者的临床资料及随访结果,其中男性9例、女性6例。年龄31~68岁,平均46.7岁。受伤原因:交通伤3例、高坠伤2例、摔伤10例。根据Mutch分型:Ⅰ型5例,Ⅱ型10例。15例患者中7例合并肩袖损伤,其中冈上肌腱4例、冈下肌腱1例、小圆肌腱1例、肩胛下肌腱损伤1例。2例肱二头肌长头腱损伤;2例Bankart损伤;3例肩关节上盂唇前后部(superior labrum anterior and posterior,SLAP)损伤。受伤至手术时间为平均4 d(2~7 d)。所有患者均在肩关节镜下完成,末次随访采用视觉模拟评分(visual analogue scale,VAS)、Constant-Murley评分和肩关节活动范围进行肩关节功能评估。结果所有患者术后均获得随访,随访时间19.8个月(10~36个月)。所有骨折均获得骨性愈合,平均愈合时间为(2.7±1.5)个月。术后12个月VAS评分1分,Constant-Murley评分为92.1分,美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)为89.5分。肩关节活动度:前屈170°(140°~180°),体侧平均外旋38.7°(20°~70°),内旋达T12水平。本组无一例出现内固定失效、骨折移位、神经血管损伤等并发症。结论肱骨大结节骨折是一种复位和固定要求极高的疾病,关节镜下张力带缝合技术治疗单纯肱骨大结节骨折是一种微创、安全有效的方法,可以获得很好的临床效果。Background Single humeral greater tuberosity fracture accounts for 17%-21%of proximal humeral fractures.According to different fracture forms of the humeral greater tuberosity,it is divided into avulsion fracture,splitting fracture and compression fracture,and the avulsion or splitting of the greater tuberosity has greater influence on rotator cuff function.Therefore,surgery is required among patients with high demand for sports if the displacement of the greater tuberosity is over 3 mm in recent years.With the enhance of knowledge and the improvement of minimally invasive devices,shoulder arthroscopic technology has become the mainstream trend of humeral greater tuberosity fracture treatment,but there are few reports on the therapeutic effect of this type of injury.Objective To investigate the clinical effect of tension band suture in the treatment of humeral greater tuberosity fracture under shoulder arthroscopy.Methods From May 2015 to June 2017,the data and follow-up results of patients who received shoulder arthroscopic tension band technique was retrospectively analyzed retrospective study was done to analyzed.Nine were males and six were females.Their ages ranged from 31 to 68 years with an average of 46.7 years.Causes of injuries:3 cases of traffic accidents,2 cases of high falls and 10 cases of fall damages.According to Mutch classification,there were 5 cases of type I and 10 cases of type II.Combined other injuries:7 of 15 patients with rotator cuff injuries,inckuding 4 cases of supraspinatus tendon injuries,1 case of infraspinatus tendon injury and 1 case of teres minor tendon injury,1 case of subscapular tendon injury.There were 2 cases of biceps long head tendon injuries,2 cases of Bankart lesions,3 cases of SLAP injuries.The duration from injury to surgery was 4 days(2-7 days).All patients received surgery under shoulder arthroscopy.Visual analogue scale(VAS),Constant-Murley score and shoulder range of motion were adopted for evaluation of shoulder joint function.Results All patients received follow

关 键 词：关节镜 切开复位 大结节骨折 固定 

分 类 号：R687.3[医药卫生—骨科学]