肱骨大结节骨折畸形愈合肩峰撞击症的治疗

Open surgical treatment for subacromial impingement secondary to malunion of humeral greater tuberosity fractures

摘要:

[目的] 探讨肩峰及大结节成形术加双排铆钉重建肩袖止点治疗肱骨大结节骨折畸形愈合肩峰撞击症的临床疗效。 [方法]2018 年 6 月—2022 年 10 月，17 例肱骨大结节骨折畸形愈合肩峰撞击症患者应用肩峰及大结节成形术加双排铆钉重建肩袖止点的手术治疗，评价患肩功能恢复效果。[结果]17 例患者均顺利手术，手术切口一期愈合，均未感染，随访时间 6~12 个月。与术前相比，末次随访时 VAS 评分 [(7.5±1.1), (1.2±0.7), P＜0.001]，UCLA 评分 [(12.9±3.8), (30.9±2.2), P＜0.001]、ConstantMurley 评分 [(50.7±12.1), (95.1±9.4), P＜0.001] 和上举 ROM [(94.9±12.1)°, (151.5±10.2)°, P＜0.001]，以及影像测量肱骨头相对高度 [(6.1±1.2) mm, (10.3±0.7) mm, P＜0.001] 均显著改善，尽管肩峰下间隙、肩峰指数和肩峰倾斜角度无显著变化 （P＞0.05）。[结论] 肩峰及大结节成形术加双排铆钉重建肩袖止点治疗肱骨大结节骨折畸形愈合肩峰撞击症，可有效改善患肩关节活动功能、改善肱骨头相对高度。

Abstract:

[Objective] To evaluate the clinical outcomes of open acromioplasty and osteoplasty of the humeral greater tuberosity combined with rotator cuff reattachment by doublerow suture anchors for the subacromial impingement secondary to malunion of humeral greater tuberosity fractures. [Methods] From June 2018 to October 2022, 17 patients received abovementioned surgical procedures for subacromial impingement secondary to malunion of humeral greater tuberosity fractures. The functional recovery of the affected shoulder was evaluated. [Results] All the 17 patients were smoothly operated on with incision healing in the first-stage without infection, and were followed up for 6~12 months. Compared with those preoperatively, the VAS score [(7.5±1.1), (1.2±0.7), P＜0.001], UCLA score [(12.9±3.8), (30.9±2.2), P＜0.001], Constant-Murley score [(50.7±12.1), (95.1±9.4), P＜0.001] and lifting ROM [(94.9±12.1)°, (151.5±10.2)°, P＜0.001], as well as relative height of humerus head measured on images [(6.1±1.2) mm, (10.3±0.7) mm, P＜0.001] were significantly improved at the latest follow-up, although there were no significant changes in subacromial space, acromial index, and acromial tilt angle (P＞0.05). [Conclusion] The open acromioplasty and osteoplasty of the humeral greater tuberosity combined with rotator cuff reattachment by double-row suture anchors do effectively improve the mobility of the affected shoulder, with improvement of the relative height of the humerus head for subacromial impingement secondary to malunion of humeral greater tuberosity fractures.