Bahrs Christian, Rolauffs Bernd, Stuby Fabian, Dietz Klaus, Weise Kuno, Helwig Peter
BG Trauma Center, Hospital for Traumatology and Reconstructive Surgery, Eberhard-Karls-University, Tuebingen, Germany.
J Trauma. 2010 Oct;69(4):901-6. doi: 10.1097/TA.0b013e3181cda518.
This study examined the effect of proximal humeral fractures on the age- and shoulder-specific prevalence of rotator cuff tears (RCTs) as well as the association with fracture severity, patient age, and clinical outcome.
Sixty-three fractures were treated conservatively; in 114 cases, minimally invasive osteosynthesis, and in 125 cases, open reduction and plate fixation were performed without rotator cuff reconstruction. After 4.4 years, all 302 patients were clinically and sonographically examined.
We examined 139 two-part, 95 three-part, and 68 four-part fractures according to Neer and 134 A, 86 B, and 82 C fractures according to the AO classification. There were 52 patients (17%) with a complete rotator tear (RCT) only at the injured shoulder and 11 patients (4%) with a complete RCT only at the contralateral shoulder (p < 0.0001). Independent of the patient's age at follow-up, the prevalence of an RCT in the fractured shoulder was 13% higher than the prevalence in the opposite shoulder. Four-part fractures showed a significant association with a complete RCT (p = 0.047).Of 74 patients with a satisfactory or poor Constant Score, 33 (44.6%) had RCTs. In the remaining 228 patients with a good to excellent result, only 26 (11.4%) had RCTs. We showed that 66% of the RCTs observed at the fractured shoulder were caused by trauma. There was no association between treatment modality and a complete RCT.
RCTs may need special attention in initial diagnostics, management, and follow-up especially in severe proximal humeral fractures.
本研究探讨肱骨近端骨折对肩袖撕裂（RCT）的年龄及肩部特异性患病率的影响，以及与骨折严重程度、患者年龄和临床结局的关联。
63例骨折采用保守治疗；114例采用微创接骨术，125例采用切开复位钢板固定术，均未进行肩袖重建。4.4年后，对所有302例患者进行临床和超声检查。
根据Neer分类，我们检查了139例二部分骨折、95例三部分骨折和68例四部分骨折；根据AO分类，检查了134例A型、86例B型和82例C型骨折。仅受伤肩部存在完全性肩袖撕裂（RCT）的患者有52例（17%），仅对侧肩部存在完全性RCT的患者有11例（4%）（p<0.0001）。随访时，无论患者年龄如何，骨折肩部RCT的患病率比另一侧肩部高13%。四部分骨折与完全性RCT显著相关（p=0.047）。在Constant评分满意或较差的74例患者中，33例（44.6%）存在RCT。在其余228例结果良好至优秀的患者中，只有26例（11.4%）存在RCT。我们发现，骨折肩部观察到的RCT中有66%是由创伤引起的。治疗方式与完全性RCT之间无关联。
在初始诊断、治疗和随访中，尤其是严重的肱骨近端骨折，RCT可能需要特别关注。
