Maier Dirk, Izadpanah K, Bayer J, Langenmair E R, Ogon P, Südkamp N P, Jaeger M
Klinik für Orthopädie und Unfallchirurgie, Klinikum der Albert-Ludwigs-Universität Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Deutschland.
Zentrum Sportorthopädie Freiburg, Freiburg, Deutschland.
Unfallchirurg. 2017 Apr;120(4):320-328. doi: 10.1007/s00113-015-0129-1.
The aim of this comparative study was to evaluate the clinical radiological outcome after open treatment of acute anterior glenoid rim fractures and to analyze the influencing factors and complications.
The study included 26 patients with an average age of 51.6 years (range 27-71 years) at surgery. The mean period of follow-up was 5.1 years (range 2.0-11.1 years). The average extent of glenoid fracture involvement was 25.5 % (range 18-35%) and three fixation techniques were applied: 1) bioresorbable pins (n = 16), 2) small fragment screws (n = 5) and 3) bioresorbable suture anchors (n = 5).
The mean score values were 80.3 points for the absolute Constant score, 87.6 points for the normalized Constant score, 88.7 points for the Rowe score, 17.4 points for the Oxford shoulder score, 10.3 points for the simple shoulder test, 13.0 points for the shoulder pain and disability index and 81.5 % for the subjective shoulder value. The fixation technique did not show a significant influence; however, multi-fragment fractures were associated with a significantly inferior absolute (73 vs. 87 points, p = 0.022) and normalized Constant scores (81 vs. 94 points, p = 0.019). Subscapularis insufficiency with internal rotation deficit was found in 10 (39 %) patients and posttraumatic osteoarthritis occurred in 6 (23 %) patients.
Open fixation yielded good or excellent shoulder function in 20 out of the 26 (77 %) patients and the clinical outcome primarily depended on the underlying type of fracture. Significantly inferior outcomes should be expected in patients with multi-fragment fractures. The main complications were subscapularis insufficiency and posttraumatic osteoarthritis.
本比较研究的目的是评估急性前盂缘骨折开放治疗后的临床影像学结果，并分析影响因素和并发症。
该研究纳入了26例手术时平均年龄为51.6岁（范围27 - 71岁）的患者。平均随访时间为5.1年（范围2.0 - 11.1年）。盂骨折累及的平均范围为25.5%（范围18 - 35%），采用了三种固定技术：1）生物可吸收针（n = 16），2）小碎片螺钉（n = 5）和3）生物可吸收缝线锚钉（n = 5）。
绝对Constant评分的平均分值为80.3分，标准化Constant评分为87.6分，Rowe评分为88.7分，牛津肩部评分为17.4分，简单肩部测试评分为10.3分，肩部疼痛与功能障碍指数评分为13.0分，主观肩部评分为81.5%。固定技术未显示出显著影响；然而，多碎片骨折与绝对Constant评分（73分对87分，p = 0.022）和标准化Constant评分（81分对94分，p = 0.019）显著较差相关。10例（39%）患者出现肩胛下肌功能不全伴内旋受限，6例（23%）患者发生创伤后骨关节炎。
26例患者中有20例（77%）开放固定后肩部功能良好或优秀，临床结果主要取决于骨折的基础类型。多碎片骨折患者的预后应显著较差。主要并发症为肩胛下肌功能不全和创伤后骨关节炎。
