Department of Orthopaedics, Pudong Medical Center, Shanghai Pudong Hospital, Fudan University, No. 2800, Gongwei Road, Shanghai, 200120, China.
J Orthop Surg Res. 2023 May 16;18(1):363. doi: 10.1186/s13018-023-03851-0.
In proximal humeral fractures, the medial calcar is often considered an important stabilizing structure. When the medial calcar is disrupted, some patients may have accompanying humeral lesser tuberosity comminution that has not been noticed. To investigate the impacts of comminuted fragments of lesser tuberosity and calcar on postoperative stability, CT results, number of fragments, cortical integrity, and the variation of neck-shaft angle were compared in patients with proximal humeral fractures.
From April 2016 to April 2021, this study included patients with senile proximal humeral fractures diagnosed by CT three-dimensional reconstruction with lesser tuberosity fractures and medial column injuries. The number of fragments in the lesser tuberosity and the continuity of medial calcar were evaluated. Postoperative stability and shoulder function were evaluated by comparing changes in neck-shaft angle and the DASH upper extremity function score from 1 week to 1 year after the operation.
A total of 131 patients were included in the study, and the results showed that the number of fragments of the lesser tuberosity was related to the integrity of the medial cortex of the humerus. That is, when there were more than two lesser tuberosity fragments, the integrity of humeral medial calcar was poor. The positive rate of the lift-off test was higher in patients with lesser tuberosity comminutions 1 year after surgery. In addition, patients with more than two lesser tuberosity fragments and continuous destruction of the medial calcar had large variations in the neck-shaft angle, high DASH scores, poor postoperative stability, and poor recovery of shoulder joint function 1 year postoperatively.
The number of humeral lesser tuberosity fragments and the integrity of the medial calcar were associated with the collapse of the humeral head and the decrease in shoulder joint stability after the proximal humeral fracture surgery. When the number of lesser tuberosity fragments was greater than two and the medial calcar was damaged, the proximal humeral fracture had poor postoperative stability and poor functional recovery of the shoulder joint, which required auxiliary internal fixation treatment.
在肱骨近端骨折中，内侧干骺端通常被认为是重要的稳定结构。当内侧干骺端骨折时，一些患者可能伴有未被注意到的肱骨小结节粉碎。为了研究粉碎的小结节和干骺端碎片对术后稳定性的影响，比较了肱骨近端骨折患者的 CT 结果、骨块数量、皮质完整性、颈干角变化和肩袖撞击试验阳性率。
2016 年 4 月至 2021 年 4 月，该研究纳入了经 CT 三维重建诊断为肱骨近端骨折伴小结节骨折和内侧柱损伤的老年患者。评估了小结节的骨块数量和内侧干骺端的连续性。通过比较术后 1 周和 1 年时颈干角和 DASH 上肢功能评分的变化，评估术后稳定性和肩关节功能。
共纳入 131 例患者，结果表明小结节骨块数量与肱骨干骺端内侧皮质的完整性有关。即当小结节有超过 2 块骨块时，肱骨内侧干骺端完整性差。术后 1 年时，肩袖撞击试验阳性率在小结节粉碎的患者中较高。此外，小结节有超过 2 块骨块且内侧干骺端连续破坏的患者，颈干角变化较大，DASH 评分较高，术后稳定性差，肩关节功能恢复不良。
肱骨小结节骨块数量和内侧干骺端完整性与肱骨近端骨折术后肱骨头塌陷和肩关节稳定性下降有关。当小结节骨块数大于 2 块且内侧干骺端受损时，肱骨近端骨折术后稳定性差，肩关节功能恢复不良，需要辅助内固定治疗。
