Yaser El-Gazzar, Edward Davis, Tim R Beals, Fred Flandry
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引用次数: 0
Abstract
Proximal humerus fractures represent one of the most common fractures in the elderly, and are increasingly treated with surgical fixation. Suture augmentation attaching the rotator cuff to the plate has been advocated to combat varus collapse and other associated complications. The objective of this study was to evaluate the contribution of rotator cuff augmentation to stability of proximal humerus fracture fixation. Twelve shoulder specimens from six cadavers underwent simulated two-part and three-part proximal humerus fractures. Matched specimens from the same cadaver were randomized to suture augmentation with locking plate fixation vs. locking plate fixation alone. Greater tuberosity fragment displacement was recorded during cyclic rotational strain of the glenohumeral joint. Greater tuberosity displacement in the two-part fracture model trended towards greater motion without suture augmentation, but did not reach statistical significance (0.032 + 0.012 mm vs. 0.213 + 0.109 mm, p = 0.130). In the three-part fracture model, there was a statistically significant decrease in fracture displacement in the presence of suture augmentation (0.068 + 0.025 mm vs. 2.392 + 0.373 mm, p < 0.001). No specimens demonstrated premature failure during cyclic loading. Suture augmentation of locking plate fixation of three-part proximal humerus fractures results in decreased fracture displacement than locked plating alone, during rotational stresses simulating in vivo rotator cuff deformation forces. (Journal of Surgical Orthopaedic Advances 31(2):119-122, 2022).
肱骨近端骨折是老年人最常见的骨折之一,越来越多地采用手术固定治疗。将肩袖连接到钢板上的缝合增强术已被提倡用于对抗内翻塌陷和其他相关并发症。本研究的目的是评估肩袖增强术对肱骨近端骨折固定稳定性的贡献。来自6具尸体的12个肩部标本进行了模拟肱骨近端两部分和三部分骨折。来自同一具尸体的匹配标本随机分为缝合增强加锁定钢板固定组和单独锁定钢板固定组。在盂肱关节循环旋转应变期间记录了大结节碎片移位。两段式骨折模型中较大的结节位移在不加缝线加固的情况下趋向于较大的运动,但没有达到统计学意义(0.032 + 0.012 mm vs. 0.213 + 0.109 mm, p = 0.130)。在三段式骨折模型中,缝线增强后骨折位移明显减少(0.068 + 0.025 mm vs. 2.392 + 0.373 mm, p < 0.001)。在循环加载过程中没有试件出现过早破坏。在模拟体内旋转袖套变形力的旋转应力下,缝合增强锁定钢板固定肱骨近端三段式骨折比单独锁定钢板减少骨折位移。[j] .外科骨科进展,31(2):119- 122,2022。