经肩峰下前外侧入路微创治疗严重外展嵌插型肱骨近端骨折

目的 初步探讨经肩峰下前外侧入路(anterolateral acromial approach,ALA)微创治疗严重外展嵌插型肱骨近端骨折的可行性和临床疗效。方法 2011年6月至2013年5月,经ALA入路行骨折复位、植骨、肩袖止点重建及经皮插入肱骨近端锁定钢板(PHILOS)微创治疗20例严重外展嵌插型肱骨近端骨折,术后进行系统肩关节功能锻炼。结果 20例患者都获得1年以上随访,平均15个月(12-36个月),所有患者术后无腋神经损伤症状,骨折均于术后6个月内愈合,术后12月随访时Constant-Murley功能评分平均为83分(79-89.5分),随访期内未出现内固定失效和肱骨头缺血坏死。结论 采用ALA入路经皮插入PHILOS微创治疗严重外展嵌插型肱骨近端骨折,能直接利用此入路内三角肌前间隙无神经血管分支的解剖区域行骨折复位和放置钢板,减少软组织剥离,避免破坏肱骨头残留血运,并且能坚强固定,有助于早期功能锻炼,疗效满意。

Minimally invasive treatment via anterolateral acromial approach for severely impacted valgus fractures of proximal humerus

Objective To evalutate the clinical results of treating severely impacted valgus fractures of the proximal part of the humerus through the anterolateral acromial approach(ALA). Methods From June 2011 to May 2013, 20 patients with a severely impacted valgus proximal humeral fracture were treated through ALA approach. Direct reduction, bonegrafe, reconstruction of the rotator cuff insertion and percutaneous plating Locking Proximal Humerus Plate(PHILOS) were well done intraoperatively. Systematic rehabilitation of the shoulder joint was performed postoperatively. Results All the patients were followed up for at least one year, with an average of 15 months (range 12-36months). No cases of axillary neurapraxia have occurred that could be attributed to the surgical approach. All fractures healed within 6 months, the average Constant-Murley score at 1 year was 83(range 79 to 89.5) points. At last follow-up, there were no patient had signs of internal fixation failure and avascular necrosis(AVN) of humeral head. Conclusion Treating severely impacted valgus proximal humeral fractures with a minimally invasive technique through ALA approach. The plane of the avascular anterior deltoid raphe is utilized for reduction and percutaneous plating directly, anterior dissection near the critical blood supply is avoided, substantial muscle retraction is minimized, and stabilized fixation is achieved. These all improve early motion of the shoulder joint and produce good clinical outcomes.