目的 分析肱骨近端小结节骨折合并锁定性肩关节后脱位患者接受手术治疗的临床转归以及影像学表现,探讨与临床结果有关的影响因素.方法 2003年4月至2010年6月,共29例连续病例确诊为肱骨小结节骨折(2部分骨折)合并锁定性肩关节后脱位,其中18例患者接受改良McLaughlin手术并获得2年以上临床随访,入选本研究.18例患者均为男性,年龄21 ～58岁,平均(40±11)岁.9例患者左侧肩关节受伤,9例右侧受伤,主力侧受伤率为9/18.患者受伤至手术时间为4 ～123 d,平均(40±42)d.术后3、6个月、1年进行随访,此后每年进行1次随访.末次随访时记录患者肩关节活动度和视觉模拟量表(VAS)评分,进行临床功能评估包括加州大学肩关节功能评分(UCLA评分)、Constant评分以及美国肩肘外科协会肩关节功能评分(ASES评分).进行肩关节X线片检查评估肱骨头缺血坏死情况.采用Pearson相关分析法和Wilcoxon秩和检验法分析患者年龄、受伤侧别以及受伤至手术时间对临床结果以及肱骨头坏死的影响作用.结果 患者随访24 ～72个月,平均(38±16)个月,患者至随访结束均未出现脱位复发.患者末次随访时VAS评分0～3分,平均(0.6±0.9)分；肩关节UCLA评分23 ～33分,平均(28±4)分.Constant评分71～96分,平均(85±8)分；ASES评分75 ～95分,平均(83±7)分.患者年龄、受伤侧别与术后肩关节活动度以及功能评分均无统计学相关性.患者受伤至手术时间与术后肩关节UCLA评分(r=0.648,P=0.004)、Constant评分(r=0.506,P=0.032)、ASES评分(r=0.517,P=0.028)均存在显著统计学相关性.结论 手术治疗肱骨小结节骨折合并锁定性肩关节后脱位能够取得满意的临床结果,术后早期随访患者功能良好.患者受伤至手术时间对术后肩关节功能评分有显著影响作用.%Objective To evaluate and compare the clinical and radiographic outcomes of both acute and chronic two-part lesser tuberosity fracture with locked posterior dislocation and analyze the risk factors for the clinical outcomes.Methods Between April 2003 and June 2010,29 patients received surgical treatment for two-part lesser tuberosity fractures with a locked posterior shoulder dislocation.Eighteen of these patients received modified McLaughlin procedures and were available for both clinical and radiographic evaluation for more than 2 years.All of the 18 patients were male.The average age was (40 ± 11) years (range,21-58 years).Nine patients had left arms involved while another 9 patients got right side involved,9 of 18 patients had their dominant side involved.The average time from initial injury to surgery was (40 ±42)days (range,4-123 days).The patients received follow-up 3 months,6 months and 1 year after the operation,and the follow-up was performed once a year.The shoulder range of motion and visual analogue scale (VAS) were recorded at the final follow-up.The functional outcomes were evaluated using University of California-Los Angeles Shoulder Scale (UCLA),Constant Score,and American Shoulder and Elbow Surgeons Shoulder Score (ASES).The degree of humeral head necrosis was analysed according to plain radiographs taken at the final follow-up.The risk factors including patients' age,dominant side involvement and time from injury to surgery on the final clinical outcomes and the degree of humeral head necrosis were also analysed using Pearson correlation analysis and Wilcoxon analysis methods.Results The mean follow-up period was (38 ± 16) months (range,24-72 months).All of the patients regained shoulder stability postoperatively.At the final follow-up,the average VAS was 0.6 ±0.9 (0-3).The average UCLA was 28 ±4 (23-33).The average Constant was 85 ±8 (71-96).The average ASES was 83 ±7 (75-95).The time from injury to surgery was identified as the risk factor regarding UCLA (r =0.648,P =0.004),Constant score (r =0.506,P=0.032) and ASES score (r =0.517,P=0.028).Conclusions Satisfactory results can be achieved with surgical treatment for lesser tuberosity fractures with locked posterior shoulder dislocations.The time from injury to surgery has a negative impact on the clinical function outcome.
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