Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Orthopaedics, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, China.
Orthop Surg. 2020 Oct;12(5):1456-1463. doi: 10.1111/os.12773. Epub 2020 Oct 18.
To compare the clinical outcomes of plate fixation and arthroscopic-assisted plate fixation in patients with displaced isolated medium-sized fractures of the greater tuberosity.
From July 2013 to October 2017, patients with displaced isolated medium-sized fractures of the greater tuberosity who underwent arthroscopic-assisted plate fixation (ASPF group) or open reduction and internal plate fixation (ORIF group) were retrospectively reviewed and analyzed. There were 19 patients in the ASPF group and 27 patients in the ORIF group, with comparable demographic characteristics. The average age of patients was 49.4 ± 12.1 years in the ASPF group and 46.9 ± 11.4 years in the ORIF group. The shoulder function reflected by the Constant-Murley (CS) scores, the American Shoulder and Elbow Surgeons (ASES) scores, and the range of motion (ROM) in the both groups at the last follow-up were analyzed in the study. Surgery time, postoperative pain, and postoperative complications were also reviewed.
A total of 46 eligible patients were included in this study. The mean follow-up was similar for the ASPF (19.4 ± 3.7 months) and the ORIF (18.2 ± 3.2 months) groups (P = 0.372). All patients had achieved primary incision healing in both groups at the last follow-up. The surgery time was 96.8 ± 11.7 min and 64.2 ± 8.3 min in the ASPF group and the ORIF group, respectively (P < 0.01). All the CS scores (P = 0.278), ASES scores (P = 0.426), and ROM were slightly better in the ASPF group than in the ORIF group, but they did not attain significant differences. In addition, there was no significant difference in the postoperative complication rate between the ASPF group (10.5%) and the ORIF group (18.5%) (P = 0.522). In the ASPF group, there was only one patient with postoperative shoulder stiffness and one case of fracture malunion. In the ORIF group, there were two cases of postoperative shoulder stiffness, two cases of fracture malunoin, and one case of subacromial impingement. Other major postoperative complications, such as fracture nonunion, pullout of the suture anchor, and screw penetration, were not observed in either group.
Arthroscopic-assisted plate fixation is effective and may be an alternative in the treatment of displaced isolated medium-sized fractures of the greater tuberosity.
比较关节镜辅助钢板固定与切开复位内固定治疗移位性孤立性大结节中型骨折的临床疗效。
回顾性分析 2013 年 7 月至 2017 年 10 月接受关节镜辅助钢板固定（ASPF 组）或切开复位内固定（ORIF 组）治疗的移位性孤立性大结节中型骨折患者。ASPF 组 19 例，ORIF 组 27 例，两组患者的一般资料具有可比性。ASPF 组患者的平均年龄为 49.4±12.1 岁，ORIF 组为 46.9±11.4 岁。研究分析了两组患者末次随访时的肩关节Constant-Murley（CS）评分、美国肩肘外科医师协会（ASES）评分和活动范围（ROM）。还对手术时间、术后疼痛和术后并发症进行了评估。
本研究共纳入 46 例符合条件的患者。ASPF 组（19.4±3.7 个月）和 ORIF 组（18.2±3.2 个月）的平均随访时间相似（P=0.372）。两组患者末次随访时均达到了主要切口愈合。ASPF 组的手术时间为 96.8±11.7 分钟，ORIF 组为 64.2±8.3 分钟（P<0.01）。ASPF 组的 CS 评分（P=0.278）、ASES 评分（P=0.426）和 ROM 均略优于 ORIF 组，但差异无统计学意义。此外，ASPF 组（10.5%）和 ORIF 组（18.5%）的术后并发症发生率差异无统计学意义（P=0.522）。ASPF 组中仅有 1 例患者术后出现肩关节僵硬，1 例患者发生骨折愈合不良。ORIF 组中术后肩关节僵硬 2 例，骨折愈合不良 2 例，肩峰下撞击 1 例。两组均未发生其他主要术后并发症，如骨折不愈合、缝线锚钉拔出和螺钉穿透。
关节镜辅助钢板固定治疗移位性孤立性大结节中型骨折是有效可行的，可作为一种替代治疗方法。
