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肱骨大结节骨折:手术治疗后的并发症和长期结果。

Greater tuberosity fractures of the humerus: complications and long-term outcomes after surgical treatment.

机构信息

Department of Orthopedic Surgery, Centro Hospitalar Universitário de Santo António, 4099-001, Porto, Portugal.

School of Medicine and Biomedical Sciences - University of Porto (ICBAS-UP), Porto, Portugal.

出版信息

Eur J Orthop Surg Traumatol. 2024 Jul;34(5):2541-2547. doi: 10.1007/s00590-024-03969-9. Epub 2024 Apr 30.

Abstract

BACKGROUND

Isolated greater tuberosity (GT) fractures typically occur in younger patients following high-energy trauma compared to humeral neck fractures. Surgical treatment is indicated when superior displacement is > 5 mm. This study aimed to assess the complications and long-term outcomes of surgically-treated GT fractures.

METHODS

A retrospective review of 39 patients who underwent surgery from 2010 to 2014 was conducted. The cohort comprised 54.6% females, with an average age of 56.74 years and a median follow-up of 6.71 years. Only 25 patients returned for reevaluation, with functional outcomes assessed using Constant-Murley score.

RESULTS

Women were older than men (63.00 ± 12.15 vs. 48.65 ± 16.93, p = 0.006). 18/39 patients (46.1%) sustained avulsion-type, 1 patient out of 39 (2.6%) depression-type, and 20/39 patients (51.3%) split-type fractures. The mean Constant-Murley score was 84.08 ± 18.36, with higher scores observed in men (p = 0.021). Avulsion-type fractures were related to higher postoperative scores compared to split fractures (p = 0.069). Post-surgical complications occurred in 20.5% of patients, with no differences noted between sexes, fracture types, or procedures.

CONCLUSION

This study enhances understanding of the long-term outcomes of surgically-treated GT fractures, aiding in treatment selection. Interfragmentary screws may be preferable in younger male patients, but are associated with the higher risk of reintervention, particularly in fragile bone. Prospective multicentric studies are warranted to further elucidate long-term results and treatment strategies.

摘要

背景

与肱骨头颈部骨折相比,孤立性大结节(GT)骨折通常发生在年轻患者遭受高能量创伤后。当向上移位> 5 毫米时,需要进行手术治疗。本研究旨在评估手术治疗 GT 骨折的并发症和长期结果。

方法

对 2010 年至 2014 年期间接受手术治疗的 39 名患者进行回顾性研究。该队列包括 54.6%的女性,平均年龄为 56.74 岁,中位随访时间为 6.71 年。仅有 25 名患者返回进行重新评估,使用 Constant-Murley 评分评估功能结果。

结果

女性比男性年龄更大(63.00±12.15 岁比 48.65±16.93 岁,p=0.006)。39 例患者中有 18 例(46.1%)为撕脱型,39 例中有 1 例(2.6%)为凹陷型,39 例中有 20 例(51.3%)为劈裂型骨折。平均 Constant-Murley 评分为 84.08±18.36,男性评分更高(p=0.021)。与劈裂型骨折相比,撕脱型骨折的术后评分更高(p=0.069)。20.5%的患者发生术后并发症,但在性别、骨折类型或手术方式之间无差异。

结论

本研究增强了对手术治疗 GT 骨折长期结果的理解,有助于治疗选择。在年轻男性患者中,可能更倾向于使用断端间螺钉,但与更高的再干预风险相关,尤其是在脆弱的骨中。需要进行前瞻性多中心研究以进一步阐明长期结果和治疗策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8f34/11291518/ebb3188a86c7/590_2024_3969_Fig1_HTML.jpg

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