Klute Lisa, Pfeifer Christian, Weiss Isabella, Mayr Agnes, Alt Volker, Kerschbaum Maximilian
Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
J Clin Med. 2021 Sep 14;10(18):4136. doi: 10.3390/jcm10184136.
It is assumed that dorsocranial displacement of the greater tuberosity in humeral head fractures is caused by rotator cuff traction. The purpose of this study was to investigate the association between rotator cuff status and displacement characteristics of the greater tuberosity in four-part humeral head fractures. Computed tomography scans of 121 patients with Neer type 4 fractures were analyzed. Fatty infiltration of the supra- and infraspinatus muscles was classified according to Goutallier. Position determination of the greater tuberosity fragment was performed in both coronary and axial planes to assess the extent of dorsocranial displacement. Considering non-varus displaced fractures, the extent of the dorsocranial displacement was significantly higher in patients with mostly inconspicuous posterosuperior rotator cuff status compared to advanced fatty degenerated cuffs (cranial displacement: Goutallier 0-1: 6.4 mm ± 4.6 mm vs. Goutallier 2-4: 4.2 mm ± 3.5 mm, = 0.020; dorsal displacement: Goutallier 0-1: 28.4° ± 32.3° vs. Goutallier 2-4: 13.1° ± 16.1°, = 0.010). In varus displaced humeral head fractures, no correlation between the displacement of the greater tuberosity and the condition of the posterosuperior rotator cuff could be detected ( ≥ 0.05). The commonly accepted theory of greater tuberosity displacement in humeral head fractures by rotator cuff traction cannot be applied to all fracture types.
一般认为，肱骨头骨折时大结节的背侧颅侧移位是由肩袖牵引引起的。本研究的目的是探讨四部分肱骨头骨折中肩袖状态与大结节移位特征之间的关系。对121例Neer 4型骨折患者的计算机断层扫描进行了分析。冈上肌和冈下肌的脂肪浸润根据Goutallier分类。在冠状面和轴面确定大结节碎片的位置，以评估背侧颅侧移位的程度。对于无内翻移位骨折，与晚期脂肪变性肩袖相比，肩袖后上部分大多不明显的患者背侧颅侧移位程度明显更高（颅侧移位：Goutallier 0 - 1级：6.4 mm±4.6 mm vs. Goutallier 2 - 4级：4.2 mm±3.5 mm，P = 0.020；背侧移位：Goutallier 0 - 1级：28.4°±32.3° vs. Goutallier 2 - 4级：13.1°±16.1°，P = 0.010）。在内翻移位的肱骨头骨折中，未检测到大结节移位与肩袖后上部分状况之间的相关性（P≥0.05）。关于肱骨头骨折时肩袖牵引导致大结节移位这一普遍接受的理论，不能适用于所有骨折类型。
