Department of Orthopedic Surgery, Incheon Sejong Hospital, Incheon, South Korea.
Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Daeheung-Dong, Jung-Gu, Daejeon, 301-723, South Korea.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):621-631. doi: 10.1007/s00590-023-03684-x. Epub 2023 Sep 5.
The purpose of this study is to compare the clinical and radiological outcomes of patients undergoing open reduction and internal fixation (OR/IF) using a plate or patients undergoing an arthroscopic suture anchor fixation for the greater tuberosity (GT) fracture of the proximal humerus. The purpose of this study is to compare the clinical and radiological outcomes of patients undergoing OR/IF or an arthroscopic suture anchor fixation for the GT fracture.
Between January, 2010 and December, 2020, 122 patients with GT fracture underwent operative fixation. Either OR/IF using proximal humeral locking plate (50 patients) or arthroscopic suture anchor (72 patients) fixation was performed. Fourteen patients were lost to follow-up and finally, 108 patients were enrolled in this study. We divided these patients into two groups: (1) OR/IF group (Group I: 44 patients) and arthroscopic anchor fixation group (Group II: 64 patients). The primary outcome was subjective shoulder function (shoulder functional scale). Secondary outcomes were range of motion, and complications including GT fixation failure, fracture migration, or neurologic complication. Also, age, sex, BMI, operation time, shoulder dislocation, fracture comminution, AP (anteroposterior), SI (superoinferior) size and displacement were evaluated and compared between two groups.
Both groups showed satisfactory clinical and radiological outcomes at mid-term follow-up. Between 2 groups, there were no significant differences in age, sex, BMI, presence of shoulder dislocation or comminution. Group II showed higher clinical scores except VAS score (p < 0.05) and longer surgical times (95.3 vs. 61.5 min). Largest fracture displacement (Group I vs. II: SI displacement: 40 vs. 13 mm, and AP displacement: 49 vs. 11 mm) and higher complication rate (p = 0.049) was found in Group I.
Both arthroscopic anchor fixation and open plate fixation methods showed satisfactory outcomes at mid-term follow-up. Among them, OR/IF is preferred for larger fracture displacement (> 5 mm) and shorter operation time However, arthroscopic anchor fixation group showed better clinical outcomes and less complications than the OR/IF group.
Level 4, Case series with subgroup analysis.
本研究旨在比较切开复位内固定（OR/IF）与关节镜下缝合锚钉固定治疗肱骨近端大结节（GT）骨折的临床和影像学结果。本研究旨在比较切开复位内固定与关节镜下缝合锚钉固定治疗肱骨近端 GT 骨折的临床和影像学结果。
2010 年 1 月至 2020 年 12 月，122 例 GT 骨折患者接受手术固定。采用肱骨近端锁定钢板（50 例）或关节镜下缝合锚钉（72 例）固定。14 例失访，最终 108 例患者纳入本研究。我们将这些患者分为两组：（1）切开复位内固定组（I 组：44 例）和关节镜下锚钉固定组（II 组：64 例）。主要结局指标为肩关节功能（肩关节功能评分）。次要结局指标为活动度，以及包括 GT 固定失败、骨折移位或神经并发症在内的并发症。同时，评估并比较两组患者的年龄、性别、BMI、肩关节脱位、骨折粉碎程度、前后位（AP）、上下位（SI）大小和移位。
两组患者在中期随访时均取得了满意的临床和影像学结果。两组间在年龄、性别、BMI、肩关节脱位或粉碎程度方面无显著差异。II 组除视觉模拟评分（VAS）外，其余临床评分均较高（p<0.05），手术时间较长（95.3 分钟比 61.5 分钟）。I 组的最大骨折移位（SI 位移：40 毫米比 13 毫米，AP 位移：49 毫米比 11 毫米）和较高的并发症发生率（p=0.049）均高于 II 组。
关节镜下锚钉固定和切开复位内固定两种方法在中期随访时均取得了满意的结果。其中，OR/IF 适用于较大的骨折移位（>5 毫米）和较短的手术时间。然而，与 OR/IF 组相比，关节镜下锚钉固定组具有更好的临床结果和较少的并发症。
4 级，有亚组分析的病例系列研究。
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