肱骨大结节解剖型钢板内固定治疗肩关节前脱位合并肱骨大结节骨折的疗效观察
|
摘要
目的观察肱骨大结节解剖型钢板内固定治疗肩关节前脱位合并肱骨大结节骨折的临床疗效,分析治疗失败的原因及其应对策略。方法回顾性分析自2015-04—2018-01采用肱骨大结节解剖型钢板内固定治疗的51例肩关节前脱位合并肱骨大结节骨折。所有患者肩关节前脱位手法复位成功(足蹬法),复位后肱骨大结节骨折移位≥5 mm,需手术治疗。结果 51例均获得随访,随访时间平均12.3(10～24)个月。43例肱骨大结节骨折达到解剖复位标准,末次随访时肩关节功能Constant-Murley评分为(92.6±4.6)分,其中优39例,良4例。8例肱骨大结节骨折块向近端回缩移位,末次随访时Constant-Murley评分为(62.2±6.2)分,其中可2例,差6例。结论肱骨大结节解剖型钢板内固定治疗肩关节前脱位合并肱骨大结节骨折可取得满意疗效,但仍有出现肱骨大结节骨折块回缩移位而导致治疗失败的可能。为降低手术失败率,需解剖复位肱骨大结节骨折并做减张固定,肩外展位下将肩袖缝合至钢板远端孔中,缩短肩袖力臂,必要时加用锚钉固定肩袖。
Objective To observe the clinical effect of anatomical plate of greater tuberosity of humerus in the treatment of anterior dislocation of shoulder joint combined with fracture of greater tuberosity of humerus, and to analyze the causes of treatment failure and coping strategies. Methods A retrospective analysis of 51 cases of anterior dislocation of shoulder joint with fracture of greater tuberosity of humerus treated with anatomical plate internal fixation from April 2015 to January 2018 was made. Manual reduction of shoulder joint was successful in all patients(foot pedal method), the fracture displacement of greater tuberosity of humerus was ≥5 mm after reduction requires surgical treatment. Results The 51 cases were followed up, the average follow-up time was 12.3(10-24) months. Forty-three cases of fracture of greater tuberosity of humerus met the standard of anatomical reduction, and the Constant-Murley score of shoulder joint was(92.6 ±4.6) at the last follow-up, 39 cases were excellent and 4 cases were good. Eight cases of transposition of the humeral greater tuberosity fracture had the proximal retraction, and the Constant-Murley score of shoulder joint was(62.2 ±6.2) at the last follow-up, 2 cases were fair and 6 cases were poor. Conclusion The treatment of anterior dislocation of shoulder joint combined with fracture of greater tuberosity of humerus with anatomical plate of greater tuberosity of humerus can achieve satisfactory results, however, there is still a possibility that the fracture of greater tuberosity of humerus may be retracted and displaced, leading to treatment failure.To reduce the rate of surgical failure, it is required to perform the anatomical reduction of fracture of greater tuberosity of humerus, and tension reduction and fixation, suture the rotator cuff into the distal hole of the plate under the shoulder abduction position, shorten shoulder cuff arm, and if necessary, fix shoulder cuff with anchor.
Objective To observe the clinical effect of anatomical plate of greater tuberosity of humerus in the treatment of anterior dislocation of shoulder joint combined with fracture of greater tuberosity of humerus, and to analyze the causes of treatment failure and coping strategies. Methods A retrospective analysis of 51 cases of anterior dislocation of shoulder joint with fracture of greater tuberosity of humerus treated with anatomical plate internal fixation from April 2015 to January 2018 was made. Manual reduction of shoulder joint was successful in all patients(foot pedal method), the fracture displacement of greater tuberosity of humerus was ≥5 mm after reduction requires surgical treatment. Results The 51 cases were followed up, the average follow-up time was 12.3(10-24) months. Forty-three cases of fracture of greater tuberosity of humerus met the standard of anatomical reduction, and the Constant-Murley score of shoulder joint was(92.6 ±4.6) at the last follow-up, 39 cases were excellent and 4 cases were good. Eight cases of transposition of the humeral greater tuberosity fracture had the proximal retraction, and the Constant-Murley score of shoulder joint was(62.2 ±6.2) at the last follow-up, 2 cases were fair and 6 cases were poor. Conclusion The treatment of anterior dislocation of shoulder joint combined with fracture of greater tuberosity of humerus with anatomical plate of greater tuberosity of humerus can achieve satisfactory results, however, there is still a possibility that the fracture of greater tuberosity of humerus may be retracted and displaced, leading to treatment failure.To reduce the rate of surgical failure, it is required to perform the anatomical reduction of fracture of greater tuberosity of humerus, and tension reduction and fixation, suture the rotator cuff into the distal hole of the plate under the shoulder abduction position, shorten shoulder cuff arm, and if necessary, fix shoulder cuff with anchor.
引文
[1]Dimakopoulos P,Panagopoulos A,Kasimatis G,et al.Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture:the necessity of operative treatment[J].J Orthop Trauma,2007,21(2):104-112.
[2]薛子超,安智全.合并大结节骨折的肩关节脱位的治疗进展[J].实用骨科杂志,2012,18(11):997-1000.
[3]Williams GR Jr,Wong KL.Two-part and three-part fractures:open reduction and internal fixation versus closed reduction and percutaneous pinning[J].Orthop Clin North Am,2000,31(1):1-21.
[4]Constant CR,Murley AH.A clinical method of functional assessment of the shoulder[J].Clin Orthop,1987,214:160-164.
[5]路焕光,高辉.手法整复肩胛骨治疗肩关节前脱位[J].中华骨科杂志,1998,18(1):55.
[6]郑昱新,张琥,刘印文,等.肩关节脱位合并肱骨大结节骨折闭合复位外固定治疗的预后因素分析[J].中国骨与关节损伤杂志,2008,23(2):122-123.
[7]王明辉,高峰,王秀会.应用新型网状解剖型钢板治疗移位肱骨大结节骨折的疗效分析[J].生物骨科材料与临床研究,2017,14(3):13-15.
[8]Hong CC,Hey DH,Murphy D.Evolving trends in surgically managed patients with proximal humerus fracture:are we different after ten years?[J].Singapore Med J,2014,55(11):574-578.
[9]Platzer P,Thalhammer G,Oberleitner G,et al.Displaced fractures of the greater tuberosity:a comparison of operative and nonoperative treatment[J].J Trauma,2008,65(4):843-848.
[10]Ji JH,Shafi M,Song IS,et al.Arthroscopic fixation technique for comminuted,displaced greater tuberosity fracture[J].Arthroscopy,2010,26(5):600-609.
[11]何耀华,赵金忠,皇甫小桥,等.肩关节镜辅助下治疗急性肱骨大结节骨折[J].中华医学杂志,2010,90(21):1494-1496.
[12]谢志云,徐志旺,朱祖巍,等.缝线桥技术结合带线锚钉内固定治疗肱骨大结节撕脱骨折[J].中国骨与关节损伤杂志,2017,32(11):1204-1205.
[13]徐云钦,李强,申屠刚,等.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[J].中国骨与关节损伤杂志,2012,27(3):203-205.
[2]薛子超,安智全.合并大结节骨折的肩关节脱位的治疗进展[J].实用骨科杂志,2012,18(11):997-1000.
[3]Williams GR Jr,Wong KL.Two-part and three-part fractures:open reduction and internal fixation versus closed reduction and percutaneous pinning[J].Orthop Clin North Am,2000,31(1):1-21.
[4]Constant CR,Murley AH.A clinical method of functional assessment of the shoulder[J].Clin Orthop,1987,214:160-164.
[5]路焕光,高辉.手法整复肩胛骨治疗肩关节前脱位[J].中华骨科杂志,1998,18(1):55.
[6]郑昱新,张琥,刘印文,等.肩关节脱位合并肱骨大结节骨折闭合复位外固定治疗的预后因素分析[J].中国骨与关节损伤杂志,2008,23(2):122-123.
[7]王明辉,高峰,王秀会.应用新型网状解剖型钢板治疗移位肱骨大结节骨折的疗效分析[J].生物骨科材料与临床研究,2017,14(3):13-15.
[8]Hong CC,Hey DH,Murphy D.Evolving trends in surgically managed patients with proximal humerus fracture:are we different after ten years?[J].Singapore Med J,2014,55(11):574-578.
[9]Platzer P,Thalhammer G,Oberleitner G,et al.Displaced fractures of the greater tuberosity:a comparison of operative and nonoperative treatment[J].J Trauma,2008,65(4):843-848.
[10]Ji JH,Shafi M,Song IS,et al.Arthroscopic fixation technique for comminuted,displaced greater tuberosity fracture[J].Arthroscopy,2010,26(5):600-609.
[11]何耀华,赵金忠,皇甫小桥,等.肩关节镜辅助下治疗急性肱骨大结节骨折[J].中华医学杂志,2010,90(21):1494-1496.
[12]谢志云,徐志旺,朱祖巍,等.缝线桥技术结合带线锚钉内固定治疗肱骨大结节撕脱骨折[J].中国骨与关节损伤杂志,2017,32(11):1204-1205.
[13]徐云钦,李强,申屠刚,等.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[J].中国骨与关节损伤杂志,2012,27(3):203-205.