摘要
目的探讨肩关节前脱位合并肩胛盂及大结节骨折的临床特点及手术治疗效果。方法回顾性分析2013年12月至2019年10月四川省骨科医院上肢科采用关节镜或切开复位内固定术治疗的26例(27例肩关节)肩关节初次前脱位合并肩胛盂及大结节骨折患者的资料。男13例,女13例;年龄22~71岁,平均49.1岁。肩胛盂骨折Goss-Ideberg分型:Ⅰa型21例,Ⅱ型6例;大结节骨折Mutch分型:压缩型3例,撕脱型6例,劈裂型18例。末次随访时采用视觉模拟评分(VAS)、Constant-Murley评分、美国肩肘外科协会评分(ASES)评估肩关节疼痛及功能情况,采用Rowe肩关节稳定性评分系统评估患肩稳定性。结果本组劈裂型骨折占肱骨大结节骨折的66.7%(18/27),前盂缘骨折占肩胛盂骨折的77.8%(21/27)。26例患者(27例肩关节)术后获12~47个月(平均18.3个月)随访。骨折愈合时间6~17周,平均11.6周。末次随访时患肩活动范围:前屈上举平均155.6°,体侧外旋平均43.6°,内旋拇指触及棘突水平L4至T8。末次随访时Constant-Murley评分平均89.2分,ASES评分平均88.9分,Rowe评分平均94.5分,VAS评分平均0.3分。结论肩关节前脱位伴肩胛盂及大结节骨折中,肱骨大结节骨折以劈裂型骨折为主,肩胛盂骨折以前盂缘骨折为主。采用关节镜下或切开复位内固定,修复肩袖,可恢复肩关节稳定性,并显著改善肩关节功能,疗效满意。
Objective To explore the clinical features and treatment of anterior shoulder dislocation complicated with fractures of glenoid and greater tuberosity(GT).Methods From December 2013 to October 2019,26 patients(27 shoulders)were treated at Department of Upper Limb,Sichuan Provincial Orthopaedic Hospital by arthroscopy or open reduction and internal fixation(ORIF).They were 13 males and 13 females with a mean age of 49.1 years(range,from 22 to 71 years).By the Goss-Ideberg classification for glenoid fractures,there were 21 cases of typeⅠa and 6 cases of typeⅡ;by the Mutch classification for GT fractures,there were 3 cases of depression type,6 cases of avulsion type and 18 cases of split type.At the last follow-up,visual analogue scale(VAS),Constant-Murley and American Shoulder&Elbow Surgeons(ASES)scores were used to evaluate the pain and function of the shoulder and the Rowe scores to assess shoulder stability.Results In this cohort,the avulsion type accounted for 66.7%(18/27)of the GT fractures and the type of anterior glenoid rim for 77.8%(21/27)of the glenoid fractures.All the 26 patients(27 shoulders)were followed up for a mean period of 18.3 months(range,from 12 to 47 months).All fractures united after 6 to 17 weeks(mean,11.6 weeks).At the last follow-up,anterior flexion and lifting averaged 155.6°,lateral external rotation 43.6°,and the internal rotation thumb touching the spinous process levels from L4 to T8.At the last follow-up,the Constant-Murley scores averaged 89.2,the ASES scores 88.9,the Rowe scores 94.5,and the VAS scores 0.3.Conclusions In anterior shoulder dislocation complicated with fractures of glenoid and GT,the GT fractures are mainly the split type and the glenoid fractures mainly the type of anterior glenoid rim.Arthroscopy or ORIF can be used to repair rotator cuff tears and restore shoulder stability,leading to significantly improved shoulder function and satisfactory therapeutic outcomes.
作者
代飞
向明
杨金松
张清
李一平
Dai Fei;Xiang Ming;Yang Jinsong;Zhang Qing;Li Yiping(Department of Upper Limb,Sichuan Provincial Orthopaedic Hospital,Chengdu 610041,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2021年第11期957-962,共6页
Chinese Journal of Orthopaedic Trauma
关键词
肩脱位
肩骨折
骨折固定术
内
肩胛盂骨折
大结节骨折
Shoulder dislocation
Shoulder fractures
Fracture fixation,internal
Glenoid fractures
Greater tuberosity fractures
