Corradini A, Campochiaro G, Gialdini M, Rebuzzi M, Baudi P
Ospedale Santa Maria Bianca, Mirandola, Modena, Italy.
Ospedale di Suzzara, Suzzara, Mantova, Italy.
Musculoskelet Surg. 2018 Oct;102(Suppl 1):41-48. doi: 10.1007/s12306-018-0558-4. Epub 2018 Oct 20.
Glenoid fractures occur as a result of direct impact of the humeral head against the glenoid rim following high-energy trauma. They frequently involve one-third of the glenoid surface with an oblique fracture rim from 2 to 6-7 o'clock, and they must not be confused with bony Bankart lesions. In medium-age patients, they are frequently associated with acute cuff tear while in older patients with chronic cuff tear: These conditions increase the instability of the shoulder if not treated. With this study, we reported the results of the arthroscopic ligamentotaxis technique treatment of acute antero-inferior glenoid fractures type IA of Ideberg with a cuff repair associated.
Eleven patients with IA Ideberg glenoid fracture were treated with ligamentotaxis technique. Mean age: 56 years (45-70); 80% dominant side; male/female: 1.2. Mean extension area of glenoid fracture: 25%. The fragment was fixated reinserting the labro-ligamentous complex with a single 2 o'clock anchor. In six patients (55%), a rotator cuff tear was present, repaired during the surgical intervention. Radiological assessment: X-rays and CT with PICO method to measure the glenoid area involved. Clinical assessment: VAS, constant score, Dash score and Rowe score.
After 30 months of follow-up (12-50), no differences in flexion, abduction, rotations and pain were reported compared to the contralateral side (p > 0.05). The mean normalized constant was 101 (60-123), and the mean Rowe was 93 (65-100). X-rays showed good healing without articular surface depressions or step in all cases. Two patients had a progression of gleno-humeral arthritis.
Acute antero-inferior glenoid rim fractures are uncommon but they are increasing in over 55 years population (frequently associated with cuff tear). Correct classification and treatment are necessary to achieve good results. The X-ray assessment includes the Neer's trauma series and the CT study with PICO measurement of glenoid fragment size. Wrong treatment can lead to chronic instability, degenerative joint disease and poor results. The arthroscopic repair with ligamentotaxis is a good solution and permits the treatment of the associated rotator cuff tear. Arthroscopic technique imposes a long learning curve. CT can be used to confirm the anatomic reduction and the healing of the fracture but since it uses X-rays it must be reserved to comminuted fractures.
肩胛盂骨折是高能创伤后肱骨头直接撞击肩胛盂边缘所致。此类骨折常累及肩胛盂表面的三分之一，骨折边缘呈2点至6 - 7点的斜行骨折，且切勿与骨性Bankart损伤相混淆。在中年患者中，常伴有急性肩袖撕裂，而老年患者则常伴有慢性肩袖撕裂：若不治疗，这些情况会增加肩部的不稳定性。通过本研究，我们报告了关节镜下韧带牵拉技术治疗Ideberg IA型急性前下肩胛盂骨折并同时进行肩袖修复的结果。
11例Ideberg IA型肩胛盂骨折患者接受了韧带牵拉技术治疗。平均年龄：56岁（45 - 70岁）；80%为优势侧；男女比例：1.2。肩胛盂骨折平均扩展面积：25%。通过单个2点位置的锚钉重新植入盂唇 - 韧带复合体来固定骨折块。6例患者（55%）存在肩袖撕裂，在手术干预期间进行了修复。影像学评估：采用X线和CT并通过PICO方法测量肩胛盂受累面积。临床评估：视觉模拟评分（VAS）、Constant评分、上肢功能障碍评分（Dash评分）和Rowe评分。
随访30个月（12 - 50个月）后，与对侧相比，在屈曲、外展、旋转和疼痛方面未报告有差异（p＞0.05）。平均标准化Constant评分为101（60 - 123），平均Rowe评分为93（65 - 100）。X线显示所有病例均愈合良好，无关节面凹陷或台阶。2例患者出现了盂肱关节炎进展。
急性前下肩胛盂边缘骨折并不常见，但在55岁以上人群中呈上升趋势（常与肩袖撕裂相关）。正确的分类和治疗对于取得良好效果至关重要。X线评估包括Neer创伤系列以及通过PICO测量肩胛盂骨折块大小的CT研究。错误的治疗可能导致慢性不稳定、退行性关节疾病和不良后果。关节镜下韧带牵拉修复是一种良好的解决方案，且能同时治疗相关的肩袖撕裂。关节镜技术需要较长的学习曲线。CT可用于确认骨折的解剖复位和愈合情况，但由于其使用X线，故仅适用于粉碎性骨折。
