Tao Fulin, Li Lin, Wang Dawei, Dong Jinlei, Zhou Dongsheng, Song Wenhao
Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
Department of Orthopedic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
Ther Clin Risk Manag. 2024 Aug 9;20:483-493. doi: 10.2147/TCRM.S455379. eCollection 2024.
This study aimed to compare the efficacy of three methods for isolated greater tuberosity fractures of the humerus.
A retrospective review of patients with isolated humeral greater tuberosity fractures between January 2013 and June 2021 in our institution. We recorded data on patient demographics, injury characteristics, preoperative and postoperative imaging findings, length of incision, operative time, and intraoperative blood loss.
A total of 107 patients met the inclusion criteria and were divided into three groups. 50 patients in group A were administered a proximal humeral internal locking system (PHILOS) plate fixed using the deltopectoral approach, 26 patients in group B were administered a PHILOS plate fixed using the deltoid-splitting approach, and 31 patients in group C were administered a novel anatomical plate fixed using the deltoid-splitting approach. No significant differences were identified in sex, age, injury mechanism, type of fracture, dominant side limb, or shoulder anterior joint dislocation. However, the operative time, blood loss, and the length of incision was shorter than in Group C. Moreover, pain was evaluated on the third and fifth days after surgery; pain was lower in Group C, and pain at the last follow-up was not different between the groups. No significant differences were identified in the Constant score, DASH score, and ROM at the last follow-up. 2 patients were diagnosed with subacromial impingement, 1 in Group A one in Group B, and 1 patient in Group B experienced axillary nerve injury after surgery.
The novel anatomical plate fixed using the deltoid-splitting approach can achieve good results in the treatment of isolated humeral greater tubercle fractures with less blood loss, shorter operative time, and shorter surgical incisions, and can relieve pain in the early postoperative period.
本研究旨在比较三种治疗肱骨大结节孤立性骨折方法的疗效。
回顾性分析2013年1月至2021年6月在我院治疗的肱骨大结节孤立性骨折患者。记录患者的人口统计学数据、损伤特征、术前和术后影像学表现、切口长度、手术时间和术中出血量。
共有107例患者符合纳入标准，分为三组。A组50例患者采用三角肌胸大肌入路使用肱骨近端锁定系统（PHILOS）钢板固定，B组26例患者采用劈开三角肌入路使用PHILOS钢板固定，C组31例患者采用劈开三角肌入路使用新型解剖钢板固定。在性别、年龄、损伤机制、骨折类型、优势侧肢体或肩关节前脱位方面未发现显著差异。然而，A组和B组的手术时间、出血量和切口长度均短于C组。此外，在术后第三天和第五天对疼痛进行评估；C组疼痛较轻，末次随访时各组间疼痛无差异。末次随访时，Constant评分、DASH评分和ROM无显著差异。2例患者被诊断为肩峰下撞击征，A组1例，B组1例，B组1例患者术后出现腋神经损伤。
采用劈开三角肌入路使用新型解剖钢板治疗肱骨大结节孤立性骨折，可获得良好疗效，具有出血量少、手术时间短、手术切口短等优点，且能在术后早期缓解疼痛。
