切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2024, Vol. 12 ›› Issue (03) : 277 -280. doi: 10.3877/cma.j.issn.2095-5790.2024.03.012

综述

肱骨大结节骨折的治疗进展
马明太1, 居家宝1, 张一翀1, 丁镇涛1, 张殿英1, 付中国1, 陈建海1,()   
  1. 1. 100044 北京大学人民医院创伤骨科 创伤救治与神经再生教育部重点实验室 国家创伤医学中心
  • 收稿日期:2023-10-18 出版日期:2024-08-05
  • 通信作者: 陈建海
  • 基金资助:
    北京大学人民医院研究与发展基金(RDJP2022-46)

Progress in the treatment of humeral tuberosity fracture

Mingtai Ma, Jiabao Ju, Yichong Zhang   

  • Received:2023-10-18 Published:2024-08-05
引用本文:

马明太, 居家宝, 张一翀, 丁镇涛, 张殿英, 付中国, 陈建海. 肱骨大结节骨折的治疗进展[J]. 中华肩肘外科电子杂志, 2024, 12(03): 277-280.

Mingtai Ma, Jiabao Ju, Yichong Zhang. Progress in the treatment of humeral tuberosity fracture[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2024, 12(03): 277-280.

肱骨大结节骨折是常见的肩部损伤,对于无移位或移位不明显的大结节骨折通过规范的保守治疗可以获得良好的预后。但如果保守治疗过程中肩关节制动不当或不恰当的锻炼可能会出现骨折块移位。对于移位超过5 mm的大结节骨折需要手术治疗。对于上肢活动要求较高的人群,大结节骨块移位超过3 mm可能会对肩袖生物力学产生不利影响并导致肩峰撞击,这种情况建议手术治疗。根据骨折形态和骨折块大小的不同,可选择的手术技术包括开放手术、小切口微创手术或关节镜手术,固定方式包括带线锚钉缝线桥、高强度缝线经骨缝合、张力带、空心螺钉、特定的大结节钢板和肱骨近端接骨板等。大结节骨折的分型系统包括:AO、Neer和骨折形态分型。由于肱骨大结节骨折发生率较高且常合并肩关节脱位、肩袖损伤,在临床评估和治疗中仍存在一些争议之处。本文对肱骨大结节骨折的治疗进展进行综述。

[1]
Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures[J]. Acta Orthop Scand,2001,72(4):365-371.
[2]
Robinson CM, Shur N, Sharpe T. Injuries associated with traumatic anterior glenohumeral dislocations[J]. J Bone Joint Surg Am, 2012, 94 (1):18-26.
[3]
Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral: current concepts[J]. Injury, 2008, 39(3):284-298.
[4]
Platzer P, Kutscha-Lissberg F, Lehr S. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity[J]. Injury,2005,36 (10):1185-1189.
[5]
Bono CM, Renard R, Levine RG. Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder[J]. J Bone Joint Surg Br ,2001,83(7): 1056-1062.
[6]
Verdano MA, Aliani D, Pellegrini A. Isolated fractures of the greater tuberosity in proximal humerus: Does the direction of displacement influence functional outcome? An analysis of displacement in greater tuberosity fractures[J]. Acta Biomed, 2013, 84(3): 219-228.
[7]
Resch H, Thöni H. Dislocation fractures of the shoulder: Special status and therapeutic concepts[J]. Orthopade, 1992, 21(2):131-139.
[8]
Platzer P, Kutscha-Lissberg F, Lehr S. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity[J]. Injury, 2005,36 (10):1185-1189.
[9]
Hebert-Davies J, Mutch J, Rouleau D. Delayed migration of greater tuberosity fractures associated with anterior shoulder dislocation[J]. J Orthop Trauma, 2015, 29(10):e396-e400.
[10]
Ogawa K, Yoshida A, Ikegami H. Isolated fractures of the greater tuberosity of the humerus: Solutions to recognizing a frequently overlooked fracture[J]. J Trauma,2003,54(4):713-717.
[11]
Bahrs C, Rolauffs B, Südkamp NP. Indications for computed tomography (CT-) diagnostics in proximal humeral fractures: A comparative study of plain radiography and computed tomography[J].BMC Musculoskelet Disord, 2009, 10:33.
[12]
Neer CS II. Displaced proximal humeral fractures: I. Classification and evaluation[J]. J Bone Joint Surg Am, 1970, 52(6):1077-1089.
[13]
Brunner A, Honigmann P, Treumann T. The impact of stereo-visualisation of three-dimensional CT datasets on the interand intraobserver reliability of the AO/OTA and Neer classifications in the assessment of fractures of the proximal humerus[J]. J Bone Joint Surg Br, 2009, 91(6):766-771.
[14]
Liu G, Guo X, Zhao Q. A new biomechanical classification system for split fractures of the humeral greater tuberosity: guidelines for surgical treatment[J]. J Orthop Surg Res, 2021, 16(1):692.
[15]
Mutch J, Laflamme GY, Hagemeister N. A new morphologic classification for greater tuberosity fractures of the proximal humerus: Validation and clinical implications[J]. Bone Joint J,2014,96-B(5):646-651.
[16]
Ju J, Ma M, Zhang Y. Fracture Line Morphology of Greater Tuberosity Fragments of Neer Three- and Four-Part Proximal Humerus Fractures[J]. Orthop Surg, 2023, 15(8):1959-1966.
[17]
Gibbons AP.Fracture of the tuberosity of the humerus by muscular violence[J]. BMJ, 1909,7:1674-1679.
[18]
Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus[J]. J Shoulder Elbow Surg, 2003, 12(6):641-649.
[19]
Edelson G, Saffuri H, Obid E. The three-dimensional anatomy of proximal humeral fractures[J]. J Shoulder Elbow Surg,2009,18(4):535-544.
[20]
Yoon YS, Cha JG. MRI Findings of Periarticular Lesions with Isolated Greater Tubercle Fractures and Dislocation[J]. Curr Med Imaging,2023,19(12):1476-1486.
[21]
Mattyasovszky SG, Burkhart KJ, Ahlers C. Isolated fractures of the greater tuberosity of the proximal humerus: Along-term retrospective study of 30 patients[J]. Acta Orthop,2011,82(6):714-720.
[22]
Khoury V, Cardinal E, Brassard P. Atrophy and fatty infiltration of the supraspinatus muscle: Sonography versus MRI[J]. AJR Am J Roentgenol,2008,190(4):1105-1111.
[23]
Patten RM, Mack LA, Wang KY. Nondisplaced fractures of the greater tuberosity of the humerus: Sonographic detection[J].Radiology,1992,182(1):201-204.
[24]
Rouleau DM, Mutch J, Laflamme GY. Surgical Treatment of Displaced Greater Tuberosity Fractures of the Humerus[J]. Am Acad Orthop Surg201624(1):46-56.
[25]
Ryan DJ, Zuckerman JD, Egol KA. Fact or fiction: the "5 mm Rule" in greater tuberosity fractures of the proximal humerus[J].Eur J Orthop Surg Traumatol,2023,33(6):2309-2315.
[26]
Robertson DD, Yuan J, Bigliani LU. Three-dimensional analysis of the proximal part of the humerus: Relevance to arthroplasty[J]. J Bone Joint Surg Am,2000,82(11):1594-1602.
[27]
Huntley SR, Lehtonen EJ, Robin JX. Outcomes of surgical fixation of greater tuberosity fractures: A systematic review[J]. Orthop Traumatol Surg Res,2020,106(6):1119-1126.
[28]
Chen YF, Zhang W, Chen Q. AO X-shaped midfoot locking plate to treat displaced isolated greater tuberosity fractures[J]. Orthopedics, 2013, 36(8):e995-e999.
[29]
Yoon TH, Choi CH, Choi YR. Clinical outcomes of minimally invasive open reduction and internal fixation by screw and washer for displaced greater tuberosity fracture of the humerus[J]. J Shoulder Elbow Surg, 2018,27(6):e173-e177.
[30]
Kuan FC, Hsu KL, Hong CK. Biomechanical comparisons of hook plate and screw fixations in split-type greater tuberosity fractures of the humerus[J]. J Shoulder Elbow Surg, 2022,31(6):1308-1315.
[31]
Lin X, Huang X, Fang K. Arthroscopic fixation of humeral greater tuberosity fracture using a W-shaped suture[J]. J Orthop Surg Res,2020,15(1):554.
[32]
Luo J, Yi GJ, Chai CX. Arthroscopic transtendinous suture bridge (Speed Bridge) for the treatment of greater tuberosity fracture of humerus[J]. Zhongguo Gu Shang, 2022, 35(9):869-873.
[33]
Zhang Q, Xiang M, Li YP. Arthroscopic Management of Glenoid and Greater Tuberosity Bipolar Fractures[J]. Orthop Surg,2020,12(5):1405-1412.
[34]
Kokkalis ZT, Papanikos E, Bavelou E. Arthroscopic reduction and fixation of greater tuberosity fractures of the humerus[J]. Eur J Orthop Surg Traumatol,2021,31(6):1055-1060.
[1] 曾敬, 吴冬冬, 邵明, 范震波, 王治国, 刘培谊, 兰海峰. 高龄髋部骨折患者不同手术时机的围手术期疗效评估[J]. 中华关节外科杂志(电子版), 2024, 18(04): 445-449.
[2] 于威, 王艺凯, 杨文博, 孟春庆, 王洪, 黄玮. 陈旧性前交叉韧带胫骨止点撕脱骨折的诊疗进展[J]. 中华关节外科杂志(电子版), 2024, 18(04): 532-537.
[3] 李程, 朱梁, 庞勇, 查国春, 仇尚, 孙伟, 冯硕. 侧侧缝合联合无结缝线桥技术治疗大型L型肩袖撕裂[J]. 中华关节外科杂志(电子版), 2024, 18(03): 301-306.
[4] 沈建成, 阮安民, 刘壮. 两种关节评分联用评价两种手术治疗老年股骨粗隆间骨折[J]. 中华关节外科杂志(电子版), 2024, 18(03): 329-336.
[5] 刘正宇, 刘春风, 王振. 改良后外侧入路半髋置换治疗股骨颈骨折的早期疗效[J]. 中华关节外科杂志(电子版), 2024, 18(03): 409-413.
[6] 杜雪清, 冯周莲, 钟佩珍, 潘杏玲. 老年股骨粗隆间骨折患者应用护士主导的共管模式[J]. 中华关节外科杂志(电子版), 2024, 18(03): 421-426.
[7] 向锋, 张锡平, 陈侠甫, 戴涛, 李艳军, 文捷. 矩形钢丝环扎联合8字钢丝张力带与传统克氏针钢丝张力带对治疗髌骨横形骨折的早中期疗效比较[J]. 中华损伤与修复杂志(电子版), 2024, 19(03): 251-254.
[8] 王涵宇, 王蕾. Bankart损伤的关节镜下修复进展[J]. 中华肩肘外科电子杂志, 2024, 12(03): 262-270.
[9] 白正林, 高明, 孟增东. 肩关节置换术后假体周围感染的研究进展[J]. 中华肩肘外科电子杂志, 2024, 12(03): 271-276.
[10] 天津市天津医院, 中国医师协会骨科医师分会肩肘外科学组, 国际矫形与创伤外科学会(SICOT)中国部肩肘外科委员会, 中国医疗保健国际交流促进会骨科学分会肩肘外科学部. 老年肱骨近端骨折诊疗策略中国专家共识(2024年版)[J]. 中华肩肘外科电子杂志, 2024, 12(03): 193-204.
[11] 李仁斌, 林凤飞. 反式全肩关节置换术治疗老年人3、4部分肱骨近端骨折[J]. 中华肩肘外科电子杂志, 2024, 12(03): 205-210.
[12] 单磊, 周君琳. 同期修复肩袖撕裂结合锁定钢板治疗老年肱骨近端骨折的特点及疗效分析[J]. 中华肩肘外科电子杂志, 2024, 12(03): 211-215.
[13] 孙海波, 李想, 左维阳, 张双江, 陈萌萌, 杨雍. 多裂肌萎缩和脂肪浸润是导致严重形变骨质疏松性椎体压缩骨折的危险因素[J]. 中华老年骨科与康复电子杂志, 2024, 10(03): 146-152.
[14] 郭昆, 杨晓峰, 李传明. 双切口双钢板内固定治疗SchatzkerⅣ型以上复杂胫骨平台骨折的安全性及中远期预后的影响[J]. 中华老年骨科与康复电子杂志, 2024, 10(03): 159-164.
[15] 李娜, 李永犇, 张青. 老年四肢骨折患者2年内再骨折的预测模型构建及验证[J]. 中华老年骨科与康复电子杂志, 2024, 10(03): 171-177.
阅读次数
全文


摘要