Department of Trauma & Orthopaedics, Peking University People's Hospital, Beijing, China.
Orthop Surg. 2023 Aug;15(8):2132-2137. doi: 10.1111/os.13536. Epub 2022 Nov 4.
Greater tuberosity (GT) fragments were communicated, and additional techniques to increase the GT fragment stability after the locking plate fixation was necessary. This study aimed to analyze the reinforcement effects on the anterior-avulsion GT fragment in Neer three-part proximal humeral fractures (PHFs) using transosseous suture and suture anchor techniques.
Eighteen fresh-frozen human cadaveric shoulder specimens were used in the study. Standardized fracture of the GT and surgical neck was created in 18 human cadaveric proximal humerus. The GT fragments were reinforced with transosseous suture (TS), suture anchor (SA), and suture in addition to the PHILOS plate fixation. The fixed humerus was tested by applying static loading to the supraspinatus tendon. Load forces and fragment displacement were evaluated by a biomechanical testing machine, and the load to 3- and 5-mm displacements, load to failure, and mode of failure were recorded for all specimens. Nonparametric variables were examined by the Kruskal-Wallis test, and the Bonferroni post hoc test was used to analyze the mean loads to create 3- and 5-mm displacements as well as the failure load.
The age, female proportion, and bone mineral density showed no statistically significant differences between the three groups. The mean loading force to create 3-mm and 5-mm displacement in the TS group (254.9 ± 77.4, 309.6 ± 152.7) were significantly higher than those in the suture group (136.1 ± 16.7, 193.4 ± 14.5) (P = 0.024, P = 0.005). For the SA group, the force to create 3- and 5-mm displacement (204.3 ± 60.9, 307.8 ± 73.5) were comparable to those in the TS group (P = 0.236, P = 0.983). Moreover, the loading force to failure in the TS group (508.6 ± 217.7) and SA group (406.6 ± 114.9) was significantly higher than that in the suture group (265.9 ± 52.1) (P = 0.021, P = 0.024). In the TS group, three failed due to tendon-bone junction rupture; bone tunnel broken occurred in two specimens; suture rupture could also be seen in one specimen. All specimens in the suture group failed because of suture rupture. In the SA group, three specimens failed due to suture rupture; two failed secondary to tendon-bone junction rupture; and one failed because of shaft fracture.
Transosseous suture is a new type of reinforcement for GT fragment in Neer-three part PHFs. The transosseous suture was superior to the suture only in the reinforcement of the anterior-avulsion GT fragment of Neer three-part PHFs, and it had comparable biomechanical strength to the suture anchor.
已有研究报道锁定钢板固定后，大结节（GT）骨折块仍存在移位的风险，需要进一步的固定技术来增加 GT 骨折块的稳定性。本研究旨在分析经骨缝合和锚钉固定技术在 Neer 三部分肱骨近端骨折（PHF）中对前上方撕脱 GT 骨折块的加固效果。
本研究共使用了 18 具新鲜冷冻的人尸体肩关节标本。在 18 个人体肱骨近端标本上标准化地造成 GT 和外科颈骨折。GT 骨折块用经骨缝线（TS）、锚钉（SA）和缝线进行加固，除了 PHILOS 钢板固定外。通过对冈上肌腱施加静态负荷来测试固定后的肱骨。通过生物力学试验机评估固定后肱骨的受力和骨折块位移，记录所有标本的负荷力、3mm 和 5mm 位移时的负荷力、失效负荷力以及失效模式。非参数变量采用 Kruskal-Wallis 检验，Bonferroni 事后检验用于分析产生 3mm 和 5mm 位移时的平均负荷力和失效负荷力。
三组之间的年龄、女性比例和骨密度无统计学差异。TS 组产生 3mm 和 5mm 位移的平均加载力（254.9±77.4、309.6±152.7）明显高于缝线组（136.1±16.7、193.4±14.5）（P=0.024、P=0.005）。SA 组产生 3mm 和 5mm 位移的力（204.3±60.9、307.8±73.5）与 TS 组相似（P=0.236、P=0.983）。此外，TS 组（508.6±217.7）和 SA 组（406.6±114.9）的失效负荷力明显高于缝线组（265.9±52.1）（P=0.021、P=0.024）。TS 组有 3 例因腱骨结合处撕裂而失效，2 例缝线断裂，1 例缝线断裂。缝线组所有标本均因缝线断裂而失效。SA 组有 3 例因缝线断裂而失效，2 例因腱骨结合处撕裂而失效，1 例因骨干骨折而失效。
经骨缝线是 Neer 三部分 PHF 中 GT 骨折块的一种新型加固方法。与单纯缝线相比，经骨缝线在加固 Neer 三部分 PHF 的前上方撕脱 GT 骨折块方面更具优势，且其生物力学强度与锚钉相当。
