关节镜治疗肩关节脱位并肱骨大结节骨折的临床研究

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摘要目的有效地对关节镜下微创Herbert钉内固定与切开复位钢板内固定对肩关节脱位合并肱骨大结节骨折的疗效差异进行评价，同时探讨其临床作用机制，最终为临床研究提供可靠、有效的循证医学证据。方法选取我院2014年1月至2015年6月收住的符合诊断标准的36例肩关节脱位合并肱骨大结节骨折患者，分为关节镜下微创Herbert钉组和切开复位钢板内固定组，分别对两组患者的平均手术时间、术中出血量、住院时间以及骨折愈合时间进行比较；同时对两组治疗后3个月UCLA评分和肩关节疗效进行比较。结果两组患者平均手术时间、术中出血量及住院时间方面关节镜下微创Herbert钉组明显优于切开复位钢板内固定组，差异有统计学意义(P＜0.05)；骨折愈合时间：关节镜下微创Herbert钉组骨折愈合时间为(9.36±0.64)周；切开复位钢板内固定组的骨折愈合时间为(10.22±0.96)周，经统计学分析，t＝－4.481，P＝0.000，差异有统计学意义；两组治疗后3个月UCLA评分比较：关节镜下微创Herbert钉的疼痛、肌肉肌力明显优于切开复位钢板内固定组，差异有统计学意义(P＜0.05)；在日常生活和满意度方面两组差异无统计学意义(P＞0.05)；总分方面差异具有统计学意义(P＜0.05)；两组治疗后肩关节疗效比较：治疗后关节镜下微创Herbert钉组优良率77.78％；切开复位钢板内固定组优良率为66.11％，两组优良率经统计学分析χ²=2.429，P＝0.048，差异有统计学意义。结论关节镜下微创Herbert钉治疗肩关节脱位合并肱骨大结节骨折具有诊断明确、操作安全、临床疗效确切以及患者依从性高等优势，是一种治疗肩关节脱位合并肱骨大结节骨折较为理想的微创治疗方案，值得临床应用。

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	姜棚菲 1
	马张稳 1
	高飞 1
	苗强 2

关键词 ：肩关节脱位, 肱骨大结节骨折, 关节镜, 微创, Herbert钉, 临床疗效

Abstract：

Objective To evaluate difference of the curative effect between arthroscopic mini-incision therapeutics Herbert nails and open reduction with internal fixation (ORIF) with plate for shoulder dislocation combined large tuberosity fracture of the proximal humerus，and to explore the potential mechanism，so as to provide reliable and effective evidence-based medicine for clinical research.Methods A total of 36 patients with shoulder dislocation combined large tuberosity fracture of the proximal humerus who were treated in our hospital from January 2014 to June 2015 were included in our study and were divided into two groups with arthroscopic mini-incision therapeutics Herbert nails and ORIF with plate.We compared the operation time，inoperative blood loss，hospitalization time and fracture healing time between the two groups，as well as the UCLA score and shoulder joint effect after treatment for 3 months.Results The average operation time，inoperative blood loss and hospitalization time of the Herbert nails under arthroscopy group was significantly better than those of the ORIF with plate group (P＜0.05).Fracture healing time of two groups：The facture healing time of the arthroscopic mini-incision therapeutics Herbert nails under arthroscopy group(9.36±0.64) weeks was shorter than the ORIF with plate group (9.36±0.64) weeks vs (10.22±0.96) weeks；t＝－4.481，P＜0.001).UCLA score after treatment for 3 months of the two groups：The UCLA score for pain and muscle strength of the arthroscopic mini-incision therapeutics Herbert nails group was higher than ORIF with plate group (P＜0.05).There was no significant difference of UCLA score for daily life and satisfaction between the two groups (P＞0.05).There was a significant difference of total UCLA score between the two groups (P＜0.05)；Curative effect of shoulder after treatment of the two groups：The excellent/good rate of the arthroscopic mini-incision therapeutics Herbert nails group was higher than the ORIF with plate group (77.78％ vs 66.11％；χ²=2.429，P＝0.048).Conclusion The arthroscopic mini-incision therapeutics Herbert nails operation is an ideal treatment method for shoulder dislocation combined large tuberosity fracture of the proximal humerus which has advantages of a clear diagnosis，safety-operation，good curative effect，and high dependability，and is worthy to promote in clinical.

Key words： shoulder dislocation greater tuberosity fractures of the proximal humerus the arthroscopy mini-incision Herbert nails clinical curative effect

基金资助:延安市科技局项目(2010KS-11)

作者简介: 姜棚菲(1979－ )，男，主治医师，延安大学附属医院骨科四病区，716000。

引用本文:

姜棚菲 1，马张稳 1，高飞 1，苗强 2. 关节镜治疗肩关节脱位并肱骨大结节骨折的临床研究[J]. 实用骨科杂志, 2017, 23(5): 395-399.
Liu Haiping，Hao Dingjun，Wang Xiaodong，et al. Treatment of Shoulder Dislocation Combined Greater Tuberosity Fractures of Proximal Humerus Under Arthroscopy. sygkzz, 2017, 23(5): 395-399.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I5/395

［1］徐云钦，李强，申屠刚，等.三种手术方法在肩关节脱位合并肱骨大结节撕脱骨折中的应用［J］.中国骨与关节损伤杂志，2012，27(3)：203-205.
［2］Robinson CM，Shur N，Sharpe T，et al.Injuries associated with traumatic anterior glenohumeral dislocations ［J］.J Bone Joint Surg (Am)，2012，94(1)：18-26.
［3］曲波，史振涛，杨志广.空心螺钉治疗肩关节脱位合并肱骨大结节骨折32例［J］.中国现代医生，2013，51(23)：156-157.
［4］朱伟民，王大平，陆伟，等.复发性肩关节前脱位的关节镜下病理分型研究［J］.中国内镜杂志，2010，16(3)：237-241.
［5］Karaca Leyla，Yuceler Zeynep，Kantarci Mecit，et al.The feasibility of dual-energy CT in differentiation of vertebral compression fractures［J］.British J Radiology，2016，89(1057)：2015-2030.
［6］Neer CS.Four-segment classification of proximal humeral fractures：purpose and reliable use［J］.J Shoulder Elbow Surg，2002，11(4)：389-400.
［7］Karno M，Kennedy J G，Lipschultz S.Community psychiatry at UCLA：a decade of training［J］.American Journal of Psychiatry，1974，131(5)：601-604.
［8］曾浪清，陈云丰，李元超，等.内侧支撑螺钉在锁定钢板治疗肱骨近端骨折中的生物力学优势［J］.医用生物力学，2013，28(3)：338-343.
［9］陈志林，袁太珍，龚国龄，等.应用肱骨近端锁定钢板治疗肱骨近端骨折［J］.中国骨与关节损伤杂志，2014，29(3)：243-245.
［10］Kadar Assaf，Sherman Haggai，Drexler Michael，et al.Anchor suture fixation of distal pole fractures of patella：twenty seven cases and comparison to partial patellectomy［J］.International orthopaedics，2016，40(1)：149-154.
［11］Park SE，Ji JH，Shafi M，et al.Arthroscopic management of occult greater tuberosity fracture of the shoulder［J］.Eur J Orthop Surg Traumatol，2014，24(4)：475-482.
［12］俸志斌，米琨，伏春华.关节镜技术在关节内骨折治疗中的应用进展［J］.中医正骨，2011，23(6)：37-39.
［13］张晋，鲁谊，朱以明，等.肩关节镜辅助经皮空心钉或缝合锚固定治疗肱骨大结节骨折［J］.中华创伤骨科杂志，2010，12(4)：303-307.
［14］费文勇，章洪喜，谢军，等.关节镜下肩峰下减压术微创治疗肩峰撞击征的临床疗效观察［J］.中国内镜杂志，2013，19(12)：1263-1267.
［15］孙翔，东靖明，舒衡生，等.使用Herbert钉治疗Lisfranc关节损伤［J］.中国矫形外科杂志，2013，21(4)：412-414.
［16］戴文涛，戴庆华，金静珍.关节镜辅助下Herbert钉内固定治疗髌骨骨折［J］.中国骨与关节损伤杂志，2013，28(4)：357.
［17］陈学强，俞立新，董伟群，等.Herbert钉内固定治疗距骨骨折20例临床体会［J］.中国骨与关节损伤杂志，2013，28(2)：185-186.