关节镜下双滑轮缝合技术固定肩胛盂前缘骨折

doi:10.3877/cma.j.issn.1674-134X.2022.01.017

目的

评估关节镜下双滑轮(double-pulley)缝合技术固定肩胛盂前缘骨折(Ideberg Ⅰa型)临床结果。

方法

回顾性分析2014年3月至2017年3月在内蒙古医科大学第二附属医院进行关节镜手术治疗的Ideberg Ⅰa型肩胛盂骨折患者10例。术前拍摄患肩X光片及CT三维重建明确诊断及分型。10例患者均在关节镜下使用double-pulley缝合技术固定肩胛盂骨折。术后3~6个月行CT三维重建评估复位及愈合情况。采用秩和检验和t检验比较术前及术后视觉模拟疼痛评分(VAS)和Rowe评分；测定肩关节活动范围；并评估术后肩关节脱位复发情况。

结果

所有患者均实现骨性愈合。术后平均随访(21.0±2.1)个月。VAS评分由术前1(1，2)改善至最后随访时的0.5(0，1)，两组差异无统计学意义(Z＝-1.583，P>0.05)；Rowe评分由术前(58±16)改善至最后随访时的(92±6)(t＝6.344，P<0.001)。术后所有患者均无肩关节复发脱位。最后随访时患肩关节活动度：前屈上举角度为(171±7)°，体侧外旋角度为(73±6)°，体侧内旋可触及胸椎T10~T7，与对侧相比没有显著性差异。所有患者手术切口无感染，无神经血管损伤。

结论

关节镜下Double-pulley缝合固定Ideberg Ⅰa型肩胛盂骨折是一种切实可行的术式。

关键词: 关节盂, 骨折, 关节镜, 回顾性研究

Objective

To evaluate the results of arthroscopic repair for Ideberg Ⅰa glenoid fracture with double-pulley technique.

Methods

Between March 2014 and March 2017, 10 patients with Ideberg Ⅰa glenoid fracture were managed with double-pulley technique. Radiographs and CT scan were obtained to further evaluate glenoid fracture before operation. Adequacy of reduction and healing of glenoid fracture were assessed by CT postoperatively at follow-up. The visual analog scale (VAS) for pain score and Rowe score for Ideberg Ⅰa glenoid fracture were compared by rank sum test and t test. The postoperative mean range of motion values and postoperative recurrence rate of shoulder dislocation were also investigated.

Results

Bone union was achieved in all the patients. Ten patients were followed up for (21.0±2.1)months. The VAS score improved from 1 (1, 2) preoperatively to 0.5 (0, 1) at the final follow-up, with no significant difference(Z=-1.583, P>0.05). The mean Rowe score improved from(58±16) to (92±6)at last follow-up (t=6.344, P<0.001). No patients experienced postoperative traumatic dislocations. The values of forward elevation were(171±7)°, external rotation(73±6)°, and the patients could touch thoracic vertebrae T10-T7 at the operated side performing internal rotation. There was no difference in range of motion compared with the contralateral limb. No patient had postoperative infection or other problems related to surgery.

Conclusion

Double-pulley technique is a valuable method for the arthroscopic treatment of Ideberg Ⅰa glenoid fracture.

Key words: Glenoid fossa, Bone fractures, Arthroscopy, Retrospective studies

图1 典型病例术前术后右肩胛影像及关节镜术中情况。图A为术前CT三维重建示右肩胛盂前缘骨折(Ideberg Ⅰa型)；图B为术中关节镜下可见右肩胛骨折移位；图C在骨折块深部及断端关节盂面分别置入一枚3.5 mm锚钉；图D双滑轮(double-pulley)技术缝合后见骨折块位置良好；图E术后CT三维重建显示骨折复位良好注：红色五星代表肩胛盂；黄色三角代表骨折块

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Arthroscopic repair for anterior glenoid fracture with double-pulley technique

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Arthroscopic repair for anterior glenoid fracture with double-pulley technique