探讨全关节镜下空心钉内固定治疗Mutch II型肱骨大结节骨折的临床疗效。

选取上海中冶医院骨科2018年1月至2020年12月收治Mutch II型肱骨大结节骨折患者65例，根据手术方法不同分为A、B两组，A组采用切开复位空心钉内固定，B组采用全关节镜下骨折复位空心钉内固定。比较两组手术时间、出血量、切口长度、住院时间、骨折愈合时间、并发症发生率、视觉模拟评分法（visual analogue scale,VAS）、美国肩肘外科协会评分（American shoulder and elbow surgeons'form, ASES） 、肩关节评分系统（ Constant评分）之间的差异。

研究患者A组纳入30例，B组纳入35例，两组术前一般资料比较差异无统计学意义（P>0.05）。所有患者均获随访，随访时间13~34个月，平均17.2个月。A组与B组出血量[（107.20±16.66）ml vs. （23.45±5.64）ml]、切口长度[（6.90±1.06）cm vs. （3.35±0.41）cm]、住院时间[（6.10±0.76）d vs. （3.54±0.85）d]，术后1 d和3 d两组患者VAS评分[（6.33±1.06）分vs. （3.57±0.81）分、（3.83±0.69）分vs. （2.14±0.91）分]比较，术后12周两组患者ASES评分[（75.50±5.62）分vs. （79.57±4.91）分]、Constant评分[（73.83±7.03）分vs. （77.14±6.10）分]，差异均有统计学意义（P<0.05）。骨折愈合时间[（62.93±5.46）d vs. （65.34±7.29）d]、手术时间[（71.50±10.40）min vs. （73.46±9.41）min]、术后6个月两组患者ASES评分[（81.27±2.94）分vs．（82.26±3.01）分]、Constant评分[（83.57±3.10）分vs. （83.26±3.52）分]，之间差异无统计学意义（P>0.05）。

与传统切开复位内固定相比，肩关节镜下空心钉内固定治疗肱骨大结节Mutch II型骨折，具有手术切口小、时间短、出血量少、住院时间短、术后疼痛感更低等优点，并且术后肩关节功能恢复更快，但两种手术方式远期效果相当。

The greater tuberosity of the humerus serves as an essential attachment site for the shoulder cuff muscles (supraspinatus, infraspinatus, and teres minor), playing a crucial role in maintaining the integrity of the shoulder cuff and shoulder joint function. Fractures of the greater tuberosity of the humerus are common clinically and require anatomical reduction, secure fixation, and early rehabilitation training to achieve optimal clinical outcomes. Traditional clinical treatments involve conservative management for greater tuberosity fractures without significant displacement, utilizing shoulder abduction bracing. Fractures displaying apparent displacement undergo open reduction and internal fixation, utilizing various methods such as plates, tension bands with Kirschner wires, cannulated screws, and suture anchors. The advantage of open reduction lies in a broader field of view, facilitating more straightforward direct reduction and allowing for a more selective choice of fixation methods. However, it involves longer incisions, leading to intense postoperative pain in patients. Consequently, during early rehabilitation, patients may struggle to adhere strictly to rehabilitation protocols due to pain, potentially resulting in complications like local tissue adhesions in the shoulder joint, leading to reduced joint mobility. With the advancement of arthroscopic techniques and the increasing acceptance of minimally invasive concepts and early rehabilitation in the medical community, more orthopedic clinicians have reported successful applications of arthroscopic methods in treating fractures of the greater tuberosity of the humerus. Despite these advancements, most clinicians continue to favor open reduction and internal fixation for managing fractures of the greater tuberosity of the humerus. Mutch type II fractures of the greater tuberosity of the humerus, characterized by larger fracture fragments and being split in nature, present a relatively straightforward reduction during surgery, aligning with the requirements of minimally invasive internal fixation under arthroscopy.

To investigate the clinical effect of total arthroscopic hollow nail fixation in treating Mutch type II humeral greater tuberosity fracture.

Sixty-five cases of Mutch type II humeral greater tuberosity fractures treated in the Department of Orthopedics in Shanghai Zhongye Hospital from January 2018 to December 2020 were selected for the study. Based on different surgical methods, these cases were divided into groups A and B. Group A underwent open reduction and internal fixation with cannulated screws, while Group B underwent fracture reduction and internal fixation with cannulated screws entirely under arthroscopy. The study aimed to compare the differences between the two groups in terms of surgical duration, blood loss, incision length, length of hospital stay, fracture healing time, incidence of complications, visual analog scale (VAS), American shoulder and elbow surgeons (ASES) score, and Constant-Murley Score.

The study included 30 cases in Group A and 35 cases in Group B, with no statistically significant differences observed in the general preoperative data between the two groups (P>0.05). All patients were followed up for a duration ranging from 13 to 34 months, with an average of 17.2 months. Comparing Group A to Group B, significant differences were noted in terms of blood loss [ (107.20±16.66) ml vs. (23.45±5.64) ml], incision length [ (6.90±1.06) cm vs. (3.35±0.41) cm], hospital stay [ (6.10±0.76) days vs. (3.54±0.85) days], and VAS scores for patients at 1 and 3 days postoperatively [ (6.33±1.06) points vs. (3.57±0.81) points and (3.83±0.69) points vs. (2.14±0.91) points, respectively]. At the 12-week postoperative mark, significant differences were also observed between the two groups in terms of ASES scores [ (75.50±5.62) points vs. (79.57±4.91) points] and Constant scores [ (73.83±7.03) points vs. (77.14±6.10) points] (P<0.05). However, no statistically significant differences were found in terms of fracture healing time [ (62.93±5.46) days vs. (65.34±7.29) days], operation time [ (71.50±10.40) minutes vs. (73.46±9.41) minutes], ASES scores at 6 months postoperatively [ (81.27±2.94) points vs. (82.26±3.01) points], and Constant scores [ (83.57±3.10) points vs. (83.26±3.52) points] between the two groups (P>0.05) .

The arthroscopic cannulated screw fixation for humeral greater tuberosity fractures of Mutch type II, compared to traditional open reduction and internal fixation, offers advantages such as smaller incisions, shorter operation time, less blood loss, shorter hospital stays, and reduced postoperative pain. Additionally, it facilitates faster recovery of shoulder joint function. However, both surgical methods yield comparable long-term outcomes.