探讨大结节解剖钢板（anatomical plate of the greater tuberosity，APGT）与肱骨近端锁定接骨板系统（proximal humeral internal locking system，PHILOS）内固定治疗伴肩关节脱位的孤立性Mutch I/II型肱骨大结节骨折的疗效差异。

纳入自2015年6月至2021年6月在本院行手术治疗的伴肩关节脱位的孤立性Mutch I/II型肱骨大结节骨折患者49例。依骨折内固定方式分为PHILOS组与APGT组，PHILOS组17例，男6例、女11例，平均年龄（61.53±8.38）岁；APGT组32例，男17例、女15例，平均年龄（56.69±12.96）岁。记录患者一般资料，比较手术切口长度、术中出血量、手术时间、骨折愈合时间，记录骨折愈合情况及并发症，术后1、3个月及末次随访采用Constant-Murlery评分评估肩关节功能，视觉模拟评分（visual analogue scale，VAS）评估肩关节活动时疼痛情况。

所有患者手术顺利，APGT组平均手术时间（55.29±8.75）min、术中平均出血量（53.24±10.15）ml、切口长度（6.71±0.92）cm；PHILOS组平均手术时间（77.19±10.23）min、术中平均出血量（71.56±13.53）ml、切口长度（10.19±1.36）cm；两组均存在差异，差异具有统计学意义（P<0.05）。PHILOS组平均随访时间（25.79±10.33）个月，APGT组（21.18±9.97）个月，差异无统计学意义（P>0.05）。随访过程中骨折均愈合，两组愈合时间差异无统计学意义（P>0.05）。无伤口感染、骨折不愈合等并发症。术后1、3个月APGT组Constant-Murlery评分均优于PHILOS组（P<0.05），末次随访两组Constant-Murlery评分及VAS评分差异无统计学意义（P>0.05）。APGT组出现肩关节僵硬1例，术后肩袖损伤1例；PHILOS组出现肩峰撞击2例，两组并发症发生率差异无统计学意义（P>0.05）。

PHILOS与APGT内固定治疗伴肩关节脱位的肱骨大结节骨折均可取得良好效果，两种内固定方式术后并发症无明显差异，APGT手术创伤小、手术时间短，早期功能恢复更佳。

Proximal humeral fractures (PHFs) account for approximately 5% of total fractures and isolated greater tuberosity fractures (IGTF) account for 20% of all PHFs. IGTF is associated with rotator cuff traction, glenoid impingement, and 10% to 30% of shoulder dislocations combined with greater tuberosity fractures. The fracture fragment of the greater tuberosity is displaced backward and upward by the traction of the supraspinatus, infraspinatus, and teres minor, resulting in the narrowed subacromial space, the increased rotator cuff lever arm, the limited abductor of the shoulder joint and the chronic shoulder pain and discomfort, which seriously affect the function of the affected shoulder. Currently, it is generally accepted that greater tuberous bone mass displacement larger than 5mm is an indication of surgery. Although the arthroscopic anchor fixation and suture bridge technology in the fixation of greater tuberous fracture has gradually increased in recent years, its shortcomings, such as high technical threshold and narrow indications, are still limited in its widespread application. The traditional open reduction, proximal humeral internal locking system (PHILOS) fixation, and anatomical plate of the greater tuberosity (APGT) fixation are still the mainstream methods. Isolated humeral greater tuberosity fracture with shoulder joint dislocation is rarely reported in previous literature.

To investigate the difference in the therapeutic effect between the APGT and the PHILOS internal fixation for Mutch type I/II isolated humerus greater tuberosity fractures with shoulder dislocations.

From June 2015 to June 2021, 49 patients with Mutch type I/II isolated humeral greater tuberosity fractures with shoulder dislocations who underwent surgical treatment in our hospital were enrolled. They were divided into the PHILOS and APGT groups according to the internal fixation method. There were 17 cases in the PHILOS group, including 6 males and 11 females, with an average age of (61.53±8.38) years. There were 32 cases in the APGT group, including 17 males and 15 females, with an average age of (56.69±12.96) years. The general data of the patients were recorded, and the length of the surgical incision, intraoperative blood loss, and operating time were compared. The bone healing time and complications were recorded. The Constant-Murley score was used to evaluate the shoulder joint function in the 1st month, 3rd month, and the last follow-up and the VAS score was used to assess the pain during joint movement.

All patients underwent successful operations. The average operation time in the APGT group was (55.29±8.75) min, the average intraoperative blood loss was (53.24±10.15) ml, and the incision length was (6.71±0.92) cm. The average operation time in the PHILOS group was (77.19±10.23) min, average intraoperative blood loss (71.56±13.53) ml, and incision length (10.19±1.36) cm. The two groups had statistically significant differences (P<0.05). The average follow-up time was (25.79±10.33) months in the PHILOS group and (21.18±9.97) months in the APGT group without statistical significance (P>0.05). All fractures healed during the follow-up, and the two groups had no statistical difference in healing time (P>0.05). There were no complications, such as wound infection and nonunion of fractures. The Constant-Murley score of the APGT group was better than that of the PHILOS in the 1st month and 3rd months after the operation (P<0.05). There were one shoulder stiffness and one postoperative rotator cuff injury in the APGT group. Two cases of acromial impingement occurred in the PHILOS group, and there was no significant difference in the incidence of complications between the two groups (P>0.05) .

Both PHILOS and APGT internal fixations can achieve good results in treating the humeral greater tuberosity fractures with shoulder dislocations. There is no significant difference in postoperative complications between the two internal fixation methods. The APGT fixation has less trauma, shorter operation time, and better early functional recovery.