Scheibel Markus, Magosch Petra, Lichtenberg Sven, Habermeyer Peter
Department of Shoulder and Elbow Surgery, ATOS-Clinic Heidelberg, Bismarckplatz 9-15, 69115 , Heidelberg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2004 Nov;12(6):568-73. doi: 10.1007/s00167-004-0495-7. Epub 2004 Mar 18.
The present study evaluates the clinical and radiological results of patients with anterior glenoid rim fractures treated with two different open surgical techniques depending on the size of the bony fragment. In patients with displaced glenoid rim fractures involving less than 25% of the glenoid surface (Type I, II and IIIA fractures) suture anchor repair was performed. Patients with a bony defect involving more than 25% of the glenoid surface (Type IIIB fractures) underwent open reduction and internal fixation using cannulated screws. After a mean follow-up of 22 months, 15 patients (mean age 42.2 years) treated with suture anchor repair achieved an average Constant Score of 85.5 points (range 67.1-100) and an average Rowe Score of 94 points (range 70-100). In six patients the bony fragment was located in an unimproved medial position compared to the preoperative X-ray. In another six patients the fragment was consolidated medially to the level of the glenoid rim, and in three cases an anatomic situation was found. Patients treated with cannulated screws (ten cases, mean age 46.6 years) had a mean follow-up of 30 months and achieved a mean Constant Score of 81.9 points (range 61.7-96.1) and a mean Rowe Score of 90 points (range 70-100). Radiologically, the bony fragment was consolidated in an anatomic position in nine out of ten cases. Three patients suffered from screw impingement and one patient had screw loosening. No recurrent subluxations or dislocations were observed in either group. Three patients in group one and one patient in group two had glenohumeral osteoarthritic changes. In cases of small glenoid-rim fractures (Type I, II and IIIA fractures), suture anchor repair resulted in an excellent clinical outcome; however, the radiological results of chronic Type I fractures revealed in many cases a non-anatomical glenoidal reconstruction. For Type IIIB fractures with significant loss of glenoid concavity, open reduction and internal fixation with cannulated screws gave good clinical and radiological results; however the early complication rate was higher.
本研究评估了根据骨块大小采用两种不同开放手术技术治疗的前盂缘骨折患者的临床和影像学结果。对于移位的盂缘骨折累及不到25%盂面的患者（I型、II型和IIIA型骨折），采用缝线锚钉修复。对于骨缺损累及超过25%盂面的患者（IIIB型骨折），采用空心螺钉进行切开复位内固定。平均随访22个月后，15例接受缝线锚钉修复的患者（平均年龄42.2岁）平均Constant评分85.5分（范围67.1 - 100），平均Rowe评分94分（范围70 - 100）。6例患者的骨块相对于术前X线片处于未改善的内侧位置。另外6例患者的骨块在内侧愈合至盂缘水平，3例达到解剖复位。接受空心螺钉治疗的患者（10例，平均年龄46.6岁）平均随访30个月，平均Constant评分81.9分（范围61.7 - 96.1），平均Rowe评分90分（范围70 - 100）。影像学上，10例中有9例骨块在解剖位置愈合。3例患者出现螺钉撞击，1例患者螺钉松动。两组均未观察到复发性半脱位或脱位。第一组3例患者和第二组1例患者出现盂肱关节骨关节炎改变。对于小的盂缘骨折（I型、II型和IIIA型骨折），缝线锚钉修复产生了优异的临床结果；然而，慢性I型骨折的影像学结果在许多情况下显示盂窝重建未达到解剖复位。对于盂窝明显凹陷丧失的IIIB型骨折，空心螺钉切开复位内固定产生了良好的临床和影像学结果；然而早期并发症发生率较高。
