Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu, China.
Orthop Surg. 2020 Oct;12(5):1421-1429. doi: 10.1111/os.12767. Epub 2020 Aug 19.
Based on the morphological characteristics of glenoid and greater tuberosity (GT) fractures and the relationship between them, we explored the injury mechanism of acute anterior shoulder dislocation associated with glenoid and GT fractures.
From December 2013 to December 2019, we retrospectively reviewed the clinical data of patients who were diagnosed with acute anterior shoulder dislocation associated with glenoid and GT fractures in our hospital. According to the fracture site, a glenoid fracture group and a greater tuberosity fracture (GT) group were established, and the morphological characteristics of both glenoid and GT fractures were measured and statistically analyzed.
A total of 41 patients (43 shoulders) met the inclusion criteria (39 unilateral shoulders and 2 bilateral shoulders). The mean age was 50.21 years (range, 22-71 years). A total of 27 shoulder injuries (62.8%) were split GT fractures and 33 shoulder injuries (76.7%) were combined with rotator cuff tears. The mean size of glenoid fragments was 30.16% and the mean displacement was 8.85 mm. The mean size of GT fragments was 28.43 mm. The mean superoinferior and anteroposterior displacements of the GT fragment were 6.77 mm and 4.96 mm, respectively. There was a negative correlation between the size of glenoid and GT fracture fragments (r = -0.64, P < 0.05). The glenoid fragments in the Ideberg type Ia glenoid fracture group were smaller than those in the Ideberg type II glenoid fracture group (28.41% and 40.95%, respectively), while the size of GT fragments in the type Ia group were larger than those in the type II group (29.77 mm and 20.21 mm, respectively) (P < 0.05). The GT fragments in the split GT fracture group were larger than those in the avulsion or depression GT fracture group (33.69 mm, 19.07 mm and 21.12 mm, respectively), while the size of glenoid fragments in the split GT fracture group were smaller than those in the avulsion or depression GT fracture group (23.57%, 41.37%, and 43.42%, respectively) (P < 0.05). As for the displacement direction of GT fragments, depression fractures were mainly inferior displacements, avulsion fractures were mainly anterosuperior displacements, while split fractures were mainly posteroinferior displacements (P < 0.05). Multiple regression analysis suggested that the type and the fragment size of GT fractures have a significant influence on the size of glenoid fragments.
Acute anterior shoulder dislocations associated with glenoid and GT fractures are often combined with rotator cuff tears. There is a negative correlation between the size of glenoid and GT fragments, and split GT fractures are most common. Such injuries are highly correlated to the relative spatial location between the GT and the glenoid when the shoulder dislocates.
基于肩盂和大结节（GT）骨折的形态特征及其之间的关系，我们探讨了急性前向肩关节脱位合并肩盂和 GT 骨折的损伤机制。
回顾性分析 2013 年 12 月至 2019 年 12 月我院收治的急性前向肩关节脱位合并肩盂和 GT 骨折患者的临床资料。根据骨折部位，建立肩盂骨折组和 GT 骨折（GT）组，测量并统计分析两组肩盂和 GT 骨折的形态特征。
共纳入 41 例（43 肩）患者（39 例为单侧肩，2 例为双侧肩）。平均年龄 50.21 岁（范围 22-71 岁）。27 例（62.8%）为 GT 劈裂骨折，33 例（76.7%）合并肩袖撕裂。肩盂骨折块的平均大小为 30.16%，平均移位 8.85mm。GT 骨折块的平均大小为 28.43mm。GT 骨折块的超顶距和前后向移位分别为 6.77mm 和 4.96mm。肩盂和 GT 骨折块大小之间存在负相关（r=-0.64，P<0.05）。Ideberg Ⅰa 型肩盂骨折组的肩盂骨折块小于 Ideberg Ⅱ型肩盂骨折组（分别为 28.41%和 40.95%），而Ⅰa 型 GT 骨折块大于Ⅱ型 GT 骨折块（分别为 29.77mm 和 20.21mm）（P<0.05）。劈裂 GT 骨折组 GT 骨折块大于撕脱或凹陷 GT 骨折组（分别为 33.69mm、19.07mm 和 21.12mm），而劈裂 GT 骨折组肩盂骨折块小于撕脱或凹陷 GT 骨折组（分别为 23.57%、41.37%和 43.42%）（P<0.05）。GT 骨折块的位移方向，凹陷骨折主要为下移位，撕脱骨折主要为前上移位，劈裂骨折主要为后下移位（P<0.05）。多元回归分析提示 GT 骨折的类型和骨折块大小对肩盂骨折块大小有显著影响。
急性前向肩关节脱位合并肩盂和 GT 骨折常合并肩袖撕裂。肩盂和 GT 骨折块大小之间存在负相关，劈裂 GT 骨折最为常见。这种损伤与肩关节脱位时 GT 与肩盂的相对空间位置关系密切。
