关节镜下双排锚钉缝线桥技术治疗肱骨大结节骨折

doi:10.3877/cma.j.issn.1674-134X.2020.05.018

中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 623 -626. doi: 10.3877/cma.j.issn.1674-134X.2020.05.018

所属专题：文献；

临床经验

关节镜下双排锚钉缝线桥技术治疗肱骨大结节骨折

卞为伟¹, 唐晓波¹^,^†(

), 王健¹, 莫向荣¹, 张浩¹, 孙健²

^1. 224700　建湖，南通大学附属建湖医院
^2. 201800　上海市第一人民医院嘉定分院

收稿日期:2018-12-05 出版日期:2020-10-01
通信作者: 唐晓波
基金资助:
南通大学临床医学专项项目(2019LY038)

Arthroscopic double-row anchor suture bridge technique in treatment of humeral greater tuberosity fractures

Weiwei Bian¹, Xiaobo Tang¹^,^†(), Jian Wang¹, Xiangrong Mo¹, Hao Zhang¹, Jian Sun²

^1. Affiliated Jianhu Hospital of Nantong University, Jianhu 224700, China
^2. Jiading Branch of Shanghai First People's Hospital, Shanghai 201800, China

Received:2018-12-05 Published:2020-10-01
Corresponding author: Xiaobo Tang
About author:
Corresponding author: Tang Xiaobo, Email: txb5122@sina.com

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目的

探讨关节镜下双排锚钉缝线桥固定技术治疗肱骨大结节撕脱性骨折的疗效。

方法

随访2013年3月至2017年3月在南通大学附属建湖医院骨科接受治疗的骨折移位大于5 mm、骨折块面积小于3 × 3 cm，无其他损伤(如：肩袖损伤、SLAP损伤、Bankart损伤)的单纯肱骨大结节撕脱性骨折的且接受关节镜下双排锚钉缝线桥固定技术治疗的患者23例。收集患者末次随访的关节活动度、疼痛视觉模拟评分(VAS)、美国肩肘外科医师(ASES)评分等数据资料。采用配对样本t检验对术前术后关节活动度、VAS评分、ASES评分进行比较。

结果

所有患者均在3个月内实现骨性愈合。肩关节前屈活动度由术前(92.4±15.3)°提高至术后(148.7±15.3)°(t＝9.956，P<0.01)，外展活动度由术前(85.0±12.6)°提高至术后(147.3±14.4)°(t＝15.502，P<0.01)；外旋活动度由术前(21.5±10.2)°提高至术后(30.7±11.8)°(t＝12.058，P<0.01); VAS评分比术前降低(Z＝4.107，P<0.01); ASES评分由术前(29.7±6.1)分提高至术后(91.8±4.1)分(t＝41.879，P<0.01)。

结论

关节镜下双排锚钉缝线桥技术治疗单纯性肱骨大结节撕脱性骨折效果确切，手术创伤小、恢复快、术后肩关节功能恢复良好。

关键词: 肩关节, 肩骨折, 内固定器, 关节镜

Objective

To explore the effect of arthroscopic double-row anchor suture bridge fixation technique in the treatment of avulsion fracture of the humeral greater tuberosity.

Methods

Twenty-three patients who underwent arthroscopic double-row anchor suture bridge fixation in Nantong University Affiliated Jianhu Hospital from March 2013 to March 2017 were followed up. The displacement of humeral tuberosity fracture in these patients was more than 5 mm, and the area of fracture fragment was less than 3 cm ×3 cm. There was no other injury, such as rotator cuff injury, superior labrum anterior and posterior (SLAP)injury, or Bankart injury. Range of motion, visual analogue scale (VAS) score and American Shoulder and Elbow Surgeon (ASES) score were collected during the last follow-up. Paired sample t test or rank sum test was used to compare the data before and after operation.

Results

Bone healing was achieved in all the patients within three months. Shoulder flexion mobility increased from preoperative(92.4±15.3)° to postoperative (148.7±15.3)°(t=9.956, P<0.01). Abduction activity increased from preoperative (85.0±12.6)° to postoperative (147.3±14.4)°(t=15.502, P<0.01. External rotation activity increased from preoperative (21.5±10.2)° to postoperative (30.7±11.8)°(t =12.058, P<0.01). The VAS scores decreased compared to the preoperative ones (Z=4.107, P<0.01). ASES score increased from preoperative (29.7±6.1) to postoperative (91.8±4.1)(t =41.879, P<0.01).

Conclusion

Arthroscopic double-row anchor suture bridge technique is effective in the treatment of simple avulsion fracture of greater tubercle of humerus, with minimal trauma, rapid recovery and good functional recovery of shoulder joint.

Key words: Shoulder joint, Shoulder fractures, Internal fixator, Arthroscopes

表1 手术前后肩关节活动度、VAS及ASES的比较(n＝23)

	前屈[°，(±s)]	外展[°，(±s)]	外旋[°，(±s)]	VAS [M(P₂₅，P ₇₅)]	ASES(±s)
术前	92.4±15.3	85.0±12.6	21.5±10.2	7.8(5.6，9.0)	29.7±6.1
术后	148.7±15.3	147.3±14.4	30.7±11.8	0.7(0.1，1.1)	91.8±4.1
统计值	t＝9.956	t＝15.502	t＝12.058	Z＝4.107	t＝41.879
P值	<0.01	<0.01	<0.01	<0.01	<0.01

表1 手术前后肩关节活动度、VAS及ASES的比较(n＝23)

	前屈[°，(±s)]	外展[°，(±s)]	外旋[°，(±s)]	VAS [M(P₂₅，P ₇₅)]	ASES(±s)
术前	92.4±15.3	85.0±12.6	21.5±10.2	7.8(5.6，9.0)	29.7±6.1
术后	148.7±15.3	147.3±14.4	30.7±11.8	0.7(0.1，1.1)	91.8±4.1
统计值	t＝9.956	t＝15.502	t＝12.058	Z＝4.107	t＝41.879
P值	<0.01	<0.01	<0.01	<0.01	<0.01

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Arthroscopic double-row anchor suture bridge technique in treatment of humeral greater tuberosity fractures