肱骨近端骨折术后镜下清理内固定物取出△

Arthroscopic release and implant removal for previous open reduction and internal fixation of proximal humeral fractures

摘要:

［目的］介绍肱骨近端骨折术后，肩关节镜下清理并在关节镜辅助下微创取出内固定装置的手术技术和初步临床效果。［方法］ 患者，男，73 岁，右肱骨近端内固定物留存、活动受限 30 个月。常规肩关节镜入路，清理盂肱关节内及肩峰下粘连的瘢痕及增生的滑膜组织，做肩峰成形等肩关节内的手术操作。增加肩关节外侧小切口入路，在关节镜辅助直视下，剥离内固定物表面覆盖软组织，显露钢板及螺钉，并完整取出内固定装置。［结果］ 术后 1 个月复查，右肩关节前屈 140°，后伸 45°，外旋 70°，内旋 60°，外展 150°，肩关节 UCLA 评分 32 分。［结论］关节镜下清理松解内固定装置取出手术操作简便、微创、有效，临床效果满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of arthroscopic release and implant re- moval for previous open reduction and internal fixation of proximal humeral fractures. [Methods] The patient, male, 73 years old, had im- plant retention of the right proximal humeral fracture accompanied with limited motion for 30 months. Conventional shoulder arthroscopy approach was used to clean up the adhesion scar and hyperplasia of synovial tissue in glenohumeral and subacromial spaces, and acromio- plasty. A small incision was added on the lateral side, as soft tissue covered on implants was debrided under arthroscopic direct vision to ex- pose the plate and screws, the internal fixation device was completely removed. [Results] One month after surgery, the patients got signifi- cant improvement in terms of range of motion and the function, with flexion of 140 degrees, extension of 45 degrees, external rotation of 70 degrees, internal rotation of 60 degrees, abduction of 150 degrees, and UCLA score of 32. [Conclusion] The arthroscopic release and im- plant removal are simple, minimally invasive and effective for previous open reduction and internal fixation of proximal humeral fractures with satisfactory clinical results.