镜下与开放手术治疗盂肱脱位合并肱骨大结节骨折△

Arthroscopic surgery versus open counterpart for glenohumeral dislocation complicated with greater tubercle fractures

摘要:

[目的] 比较镜下与开放手术治疗盂肱关节脱位合并肱骨大结节撕脱骨折的临床效果。[方法] 回顾性分析2021 年5 月—2022 年2 月本院手术治疗盂肱关节脱位合并肱骨大结节撕脱骨折80 例患者的临床资料。根据医患沟通结果，42 例采用肩关节镜下双排锚钉缝线桥固定（镜下组），37 例采用肱骨近端锁定钢板内固定（开放组），比较两组围手术期、随访及影像资料。[结果] 虽然镜下组手术时间显著长于开放组[(75.2±9.4) min vs (62.5±9.3) min, P＜0.001]，但是镜下组在术中失血量[(28.5±7.5) ml vs (85.1±8.5) ml, P＜0.001]、切口总长度[(1.3±0.6) cm vs (5.0±2.2) cm, P＜0.001]、主动活动时间[(3.1±0.9) 周vs (3.9±0.9) 周, P＜0.001]、住院时间[(8.3±1.2) d vs (9.6±1.6) d, P＜0.001] 和术后并发症发生率（0% vs 18.9%, P=0.010） 均显著优于开放组。术后随时间推移，两组患者VAS、ASES、Constant-Murley 评分及前屈、外展、外旋ROM 均显著改善（P＜0.05）。术后3、6 及12 个月时，镜下组上述指标均显著优于开放组（P＜0.05）。影像方面，镜下组骨折复位优良率显著高于开放组[优/良/可/差, (25/17/1/0) vs (18/12/5/2), P=0.036]。术后3、12 个月镜下组SAI 显著小于开放组（P＜0.05）。[结论] 肩关节镜微创治疗盂肱关节脱位合并肱骨大结节撕脱骨折的效果优于开放手术。

Abstract:

[Objective] To compare the clinical outcomes of arthroscopic surgery versus open counterpart for glenohumeral dislocationcomplicated with avulsion fracture of the humeral greater tubercle. [Methods] A retrospective study was done on 80 patients who receivedsurgical treatment for glenohumeral dislocation combined with avulsion fracture of humeral greater tubercle from May 2021 to February2022. According to the doctor-patient communication, 42 patients underwent arthroscopic reduction and double-row anchor suture bridgefixation (the arthroscopic group), while other 37 patients received open reduction and fixation with proximal humeral locking plate (opengroup). The perioperative period, follow-up and imaging data of the two groups were compared. [Results] Although the arthroscopic groupconsumed significantly longer operative time than the open group [(75.2±9.4) min vs (62.5±9.3) min, P＜0.001], the former proved signifi-cantly superior to the latter in terms of intraoperative blood loss [(28.5±7.5) ml vs (85.1±8.5) ml, P＜0.001], total length of incision [(1.3±0.6)cm vs (5.0±2.2) cm, P＜0.001], active activity time [(3.1±0.9) weeks vs (3.9±0.9) weeks, P＜0.001] and hospital stay [(8.3±1.2) days vs (9.6±1.6) days, P＜0.001] and incidence of postoperative complications (0% vs 18.9%, P=0.010). As time went by after surgery, the VAS, ASESand Constant-Murley scores, as well as anterior flexion, abduction and external rotation ROMs were significantly improved in both groups(P＜0.05). At 3, 6 and 12 months after surgery, the arthroscopic group were significantly better than the open group in terms of abovemen-tioned items (P＜0.05). With respect of imaging, the arthroscopic group was also superior to the open group in fracture reduction quality [ex-cellent/good/fair/poor, (25/17/1/0) vs (18/12/5/2), P=0.036]. At 3 months and 12 months after surgery, the arthroscopic group had significant-ly less subacromial interval (SAI) than the open group (P＜0.05). [Conclusion] Minimally invasive shoulder arthroscopy achieves better clin-ical consequences than the traditional open surgery in the treatment of glenohumeral dislocation complicated with avulsion fracture of hu-meral greater tubercle.