全关节镜下双排缝合锚钉修复肱骨大结节MutchⅠ型骨折的临床分析

摘要

背景:肱骨大结节系肩袖附着点,在肩关节中起至关重要的作用,而单独的肱骨大结节分型目前文献及相关报道很少,更多的停留在Neer和AO分型,对该骨折的固定方式没有系统规范的共识,尚存在很多争议.目的:探讨在全关节镜下双排缝合锚钉治疗肱骨大结节撕脱骨折(MutchⅠ型)的临床疗效.方法:回顾性分析Mutch I型肱骨大结节骨折行全关节镜下双排缝合锚钉固定治疗的24例患者临床资料.用CT(2D)进行客观测量内固定前、后肱骨大结节向上移位距离,并在内固定前、内固定后1,3,6,12个月分别用Constant-Murley Score(CMS)、UCLA评分对所有患者进行主观评估,以及内固定前、后12个月进行疼痛目测类比评分评估.结果与结论:①双排缝合锚钉能有效恢复大结节的移位并对肩袖损伤进行修复;②24例患者里合并肩袖损伤者为79.16%;③各时间段CMS、UCLA评分均优于前一时间点分值(P<0.05);内固定后12个月目测类比评分显著优于内固定前(P<0.05);④结果表明,全关节镜下双排缝合锚钉修复肱骨大结节MutchⅠ型骨折,能有效的恢复大结节骨折的移位并缓解患者疼痛,有利于早期的肩关节功能锻炼,是一种创伤小、临床疗效良好的手术方式.%BACKGROUND: Greater tuberosity of humerus, as the attachment point of rotator cuff, plays a vital role in shoulder.Neer and AO classification for proximal humeral fractures have been accepted extensively. However, the classification for single greater tuberosity fractures of the proximal humerus is little reported, and its fixation method remains controversial.OBJECTIVE: To explore the curative efficacy of the double-row suture anchors under arthroscopy for avulsion-type greater tuberosity fractures (Mutch type Ⅰ) METHODS: Clinical data of 24 patients with avulsion-type greater tuberosity fractures (Mutch type Ⅰ) undergoing double-row suture anchors under arthroscopy were analyzed retrospectively. The displacement distance of the greater tuberosity of humerus was measured on CT before and after fixation. The shoulder joint was evaluated by Constant-Murley Score and the University of California, Los Angeles score at baseline, 1, 3, 6 and 12 months postoperatively. Besides, the visual analogue scale scores were detected at baseline and 12 months postoperatively.RESULTS AND CONCLUSION: (1) Double-row suture anchors effectively improved the displacement of greater tuberosity and rotator cuff injury. (2) The patients accompanied by rotator cuff injury accounted for 79.16%. (3) The Constant-Murley Score and the University of California, Los Angeles scores were significantly improved at each time point (P < 0.05). The visual analogue scale scores after fixation were significantly superior to those before fixation (P < 0.05). (4) These results suggest that the double-row suture anchors under arthroscopy can effectively improve the displacement of greater tuberosity and alleviate the pain. Moreover, it is conductive for early recovery of the shoulder function with little trauma, so it is a good choice for avulsion-type greater tuberosity fractures (Mutch type Ⅰ).