中华肩肘外科电子杂志
中華肩肘外科電子雜誌
중화견주외과전자잡지
Chinese Journal of Shoulder and Elbow (Electronic Edition)
2014年
4期
225-229
,共5页
韩立强%江汉%肖联平%杨国跃%江毅%张殿英
韓立彊%江漢%肖聯平%楊國躍%江毅%張殿英
한립강%강한%초련평%양국약%강의%장전영
肱骨骨折,近端%微创%锁定钢板%切口
肱骨骨摺,近耑%微創%鎖定鋼闆%切口
굉골골절,근단%미창%쇄정강판%절구
Humeral fracture,proximal%Minimally invasion%Locking compression plate%Incision
目的：回顾性分析 T 形切口下微创锁定钢板治疗肱骨近端骨折的疗效。方法自2011年1月至2013年8月,我院收治肱骨近端骨折患者35例,分类方法采用 AO 分型,其中11-A2型7例,11-A3型12例,11-B1型8例,11-B2型6例,11-C1型2例,均采用T型切口下锁定钢板手术治疗,术后2~3d开始肩关节被动活动锻炼,逐渐增加活动范围,术后2 周开始肩关节摆动锻炼,术后3周开始肩关节锻炼,并采用 Neer肩关节功能评分。结果本组 3 5例患者手术切口均一期愈合,所有患者均得到随访,随访时间5~16个月,平均13.1个月,骨折均骨性愈合,术后未发现腋神经损害表现,未发现退钉、钢板松动。Neer肩关节功能评分：优19例,良10例,可6例。结论 T 形切口下微创锁定钢板治疗肱骨近端骨折具有创伤小、功能恢复快、临床疗效佳的优点,尤其适于 AO 分型的A2、A3型和B型骨折的治疗。
目的：迴顧性分析 T 形切口下微創鎖定鋼闆治療肱骨近耑骨摺的療效。方法自2011年1月至2013年8月,我院收治肱骨近耑骨摺患者35例,分類方法採用 AO 分型,其中11-A2型7例,11-A3型12例,11-B1型8例,11-B2型6例,11-C1型2例,均採用T型切口下鎖定鋼闆手術治療,術後2~3d開始肩關節被動活動鍛煉,逐漸增加活動範圍,術後2 週開始肩關節襬動鍛煉,術後3週開始肩關節鍛煉,併採用 Neer肩關節功能評分。結果本組 3 5例患者手術切口均一期愈閤,所有患者均得到隨訪,隨訪時間5~16箇月,平均13.1箇月,骨摺均骨性愈閤,術後未髮現腋神經損害錶現,未髮現退釘、鋼闆鬆動。Neer肩關節功能評分：優19例,良10例,可6例。結論 T 形切口下微創鎖定鋼闆治療肱骨近耑骨摺具有創傷小、功能恢複快、臨床療效佳的優點,尤其適于 AO 分型的A2、A3型和B型骨摺的治療。
목적：회고성분석 T 형절구하미창쇄정강판치료굉골근단골절적료효。방법자2011년1월지2013년8월,아원수치굉골근단골절환자35례,분류방법채용 AO 분형,기중11-A2형7례,11-A3형12례,11-B1형8례,11-B2형6례,11-C1형2례,균채용T형절구하쇄정강판수술치료,술후2~3d개시견관절피동활동단련,축점증가활동범위,술후2 주개시견관절파동단련,술후3주개시견관절단련,병채용 Neer견관절공능평분。결과본조 3 5례환자수술절구균일기유합,소유환자균득도수방,수방시간5~16개월,평균13.1개월,골절균골성유합,술후미발현액신경손해표현,미발현퇴정、강판송동。Neer견관절공능평분：우19례,량10례,가6례。결론 T 형절구하미창쇄정강판치료굉골근단골절구유창상소、공능회복쾌、림상료효가적우점,우기괄우 AO 분형적A2、A3형화B형골절적치료。
Background With the aging of population,the proximal humerus fractures are becoming more and more common.The displaced proximal humeral fractures often result in long-term disability.For the instability and displacement of the fracture,the operation treatment is of the best effect so far.At present,the locking plate has been widely used in the treatment of proximal humerus fractures,and has already achieved good clinical results.This paper retrospectively analysis the functional effect of minimally invasive locking plate in the treatment of proximal humeral fractures in our hospital with T shape incision.Methods Thirty-five cases in our hospital suffered from proximal humeral fractures were included in this study (16 males,19 females,aged 31-72 years old)during the past years.The average age was 56.3 years old.Fifteen cases were injured on the left side,20 cases were injured on the right side.All the fractures were fresh.The cause of injury:20 cases were living accident,6 cases were of high falling inj ury,9 cases were of traffic accident.All the Patients had undergone X-ray examinations and three-dimensional CT reconstruction before receiving surgery. According to the AO classification,there were 7 cases of type 11-A2,12 cases of type 11-A3,8 cases of type 1 1-B1 ,6 cases of type 1 1-B2 and type 1 1-C1 in 2 cases.All were treated with locking plates through the type T incision.Patients were in the beach chair position after anesthesia to get operation. Then mark the operating incision,the axillary nerve and the acromion on the surface before surgery. A 6 cm transverse incision was made one finger subacromially in the lateral side of shoulder.The subcutaneous tissue was incised before a longitudinal dissection of the deep fascia.Find the anterior and middle part of the deltoid muscle by identifying the fat fiber lines between the gap and the muscle belly.Bluntly split it longitudinally,not exceeding 6 cm of the distance in order to avoid the inj ury of axillary nerve.Stretch the splitted deltoid to the sides,expose deltoid bursa,incise it longitudinally to expose the greater tuberosity of humerus and the fracture.Make the reduction by poking and manual pressing the fracture with the traction of the shoulder in the abduction position. Take the intertubercular sulcus and greater tuberosity as the reduction index,then flex and abduct the elbow after a satisfactory reduction to guarantee the 30-40 degree retroverted angle,fix it with the Kirschner wire temporarily and then select a steel plate with an appropriate length (select AO Synthes,PHILOS steel plate).Then make a 3 cm longitudinal incision on the distal part of the fracture,implant the steel plate along the periosteum ,place the plate 5-8 mm upper the greater tuberosity ,2-4 mm laterally of the intertubercular sulcus .After an satisfactory position of the C-arm fluoroscopy, implant 5-9 locking screws proximally and 3 bicortical locking screws distally,place a drainage tube conventionally. Sling the arm with a triangular scarf for immobilization for 3 to 4 weeks postoperatively.Results The operation incision of the 35 patients of this group got healed in the first period.They were required to exercise the shoulder joint passively after 2-3 days postoperatively. Increase the range of motion gradually.Then start to do the shoulder swing exercise 2 weeks after operation,try the lift,abduction,posterior extension and flexion exercise 3 weeks after operation.All the patients were followed up from 5 to 16 months,averagely 13.1 months.All the fractures got healed,there was no sign of damage of the axillary nerve.No loosening of the nails and plate were found.For the Neer score:there are 19 cases of excellence,10 cases of good,6 cases of fair. Conclusions Minimal invasion refers to an operation or a check with less invasion and less physiological disturbance to achieve the best operation effect,the main feature is the micro trauma. Accidental trauma does great harm to the human body,and it is really hard to avoid.But as a planned trauma of surgical operation,surgeons have to try all they can to minimize the trauma,that is to say, to achieve the goal of minimal invasion.This concept has achieved great development now in various fields of orthopedics, it commits to the protection of soft tissue and obtaining better prognosis function,which has gradually become a consensus and been confirmed by clinical effect.When we comes to the fracture of the proximal humerus,in strict confidence condition operation indications,the minimally invasive locking plate treatment under T shaped incision has the advantage of less trauma, quicker recovery and perfect clinical curative effect,which is especially suitable for AO type A2,type A3 and type B fractures.But this group of patients lack the related supportive study for the degree of deltoid muscle damage and the comparison of traditional pectoralis major-deltoid muscle approach,if we can take a detection of deltoid muscle electromyography in the postoperative follow-up to ensure the degree of injury,and then establish a control group of the pectoralis major-deltoid muscle approach,then it would be more clinically convincing.
