华西医学

华西医学

难复性肩关节脱位伴肱骨大结节骨折的手术治疗

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目的探讨切开复位空心螺钉结合铆钉内固定治疗难复性肩关节脱位伴肱骨大结节骨折的疗效。方法2011 年 1 月—2014 年 3 月,对 15 例难复性肩关节脱位伴肱骨大结节骨折的患者行切开复位空心螺钉固定大结节同时铆钉修复损伤的肩袖组织,并随访观察手术效果。其中男 9 例,女 6 例;年龄 45~77 岁,平均 63.5 岁;致伤原因:摔伤 7 例,高处坠落伤 5 例,交通事故伤 3 例;伤后至入院时间为 2 h~5 d,平均 1.5 d。肩关节均为初次脱位,脱位类型:前脱位 14 例,后脱位 1 例。其中大结节单纯撕脱骨折 9 例,粉碎性骨折 5 例,同时合并有大、小结节骨折 1 例,伴有不全神经损伤症状 2 例,术中未做探查。结果14 例切口 Ⅰ 期愈合;1 例切口发生浅表感染,经清创术及抗感染后愈合。15 例患者均获随访,随访时间 6~18 个月,平均 12.2 个月。1 例术后 1 个月肩关节再次脱位,2 例大结节缺损吸收。术后 1 年肩关节功能按照 Neer 评分系统进行评价,获优 9 例,良 3 例,可 2 例,差 1 例,优良率 80.0%。结论切开复位空心螺钉结合铆钉内固定治疗难复性肩关节脱位伴肱骨大结节骨折疗效确切,术后可获得较满意的肩关节功能。

ObjectiveTo explore the clinical effect of open reduction and internal fixation with hollow screw fixation in the treatment of difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus.MethodsFrom January 2011 to March 2014, 15 patients with difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus were treated with open reduction and hollow screw fixation. There were 9 males and 6 females, aged from 45 to 77 years with an average of 63.5 years. The causes of injury included 7 cases of falls, 5 cases of high falling injury, and 3 cases of traffic accident injury. The injury-to-admission time was 2 hours to 5 days with an average of 1.5 days. The shoulder joint was the initial dislocation. The types of dislocation showed 14 cases of anterior dislocation and 1 case of posterior dislocation. There were 9 cases of simple avulsion fracture of greater tuberosity of humerus, 5 cases of comminuted fracture, 1 case of both greater tuberosity of humeru with small tuberosity of humerus fracture, and 2 cases of incomplete nerve injury; no exploration was carried out in operation.ResultsThere were 14 patients with wound healing at first intention; 1 suffered superficial infection of the wound, which healed by anti infection treatment. Fifteen cases were followed up for 6 to 18 months with an average of 12.2 months, with 1 case of shoulder joint re-dislocation 1 month after operation, and 2 cases of tuberosity of humerus defect absorption. One year after operation, the shoulder joint function were evaluated according to Neer Scoring System, and the results were excellent in 9 cases, good in 3 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 80.0%.ConclusionThe curative effect of open reduction and internal fixation with hollow screw fixation on difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus is remarkable, which can obtain satisfactory shoulder joint function.

关键词: 肩关节; 脱位; 肱骨大结节; 骨折

Key words: Shoulder joint; Dislocation; Greater tuberosity of humerus; Fracture

引用本文: 万永鲜, 阳运康, 徐丽丽, 卓乃强, 葛建华, 鲁晓波. 难复性肩关节脱位伴肱骨大结节骨折的手术治疗. 华西医学, 2018, 33(9): 1090-1093. doi: 10.7507/1002-0179.201608021 复制

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