肱骨近端骨折倒L形入路设计与应用△

Design and application of inverted L-shaped approach for proximal humerus fracture

摘要:

[目的]介绍肱骨近端骨折倒“L”形入路设计与应用的手术技术和初步临床结果。[方法]2021年6月—2022年6 月，20例肱骨近端骨折患者采用倒“L”形入路治疗，沿肩峰突从肩峰的前外侧角开始到后外侧角延伸的水平行皮肤切口，分离皮肤、皮下、筋膜层，从肩峰突的前外侧角切开，纵向向下至手臂外侧长约4cm，切开皮肤和皮下组，沿水平切口长度从肩峰突脱离三角肌，向后拉伸三角肌瓣，确定暴露区域，清除碎骨块和血凝块，复位骨折，用2枚克氏针临时固定碎骨块，然后紧贴着骨质表面放入PHILOS钢板。[结果]尸体标本测量暴露面积由大到小依次为倒“L”形入路、三角肌劈开入路和三角肌胸大肌入路[(20.6±5.6)cm2vs(15.1±3.7)cm2vs(14.0±5.0)cm2,P＜0.001]。所有患者均顺利完成手术，术中无神经损伤等并发症， 患者均获随访，随访时间平均（13.2±3.4）个月，术后6个月X线片示骨折均愈合，骨折愈合时间平均（127.5±11.5）d，随访 12个月，Constant评分由术前（45.3±2.6）分显著增加到末次随访的（94.9±2.2）分。[结论]倒“L”形入路治疗肱骨近端骨折方便可行，早期效果满意。

Abstract:

[Objective] To introduce the design and application of the inverted L-shaped approach for proximal humerus fractures andthe preliminary clinical results. [Method] From June 2021 to June 2022, 20 patients with proximal humeral fractures were treated throughan inverted "L" approach. A horizontal skin incisions were extended along the acromial process from the anterolateral to the posterolateralborder. After skin, subcutaneous and fascial layers were cut, and the incision was extended about 4 cm in length down to the lateral arm.The deltoid was detached from the acromial process along the length of the horizontal incision, the deltoid flap was stretched backwards, theexposed area was identified. As the bone fragments and blood clots were removed, the fracture was reduced, were temporarily immobilizedwith 2 Kirschner wires, and then fixed by PHILOS plate. [Results] The exposed areas measured in the cadaveric specimens were ranked asinverted "L" approach, deltoid split approach and pectodeltoid approach [(20.6±5.6) cm2 vs (15.1±3.7) cm2 vs (14.0±5.0) cm2, P＜0.001]. Allpatients had open reduction and internal fixation performed successfully without any complications, such as nerve damage during the opera-tion. All patients were followed up for an average of (13.2±3.4) months. The X-rays showed that all fractures were healed 6 months after theoperation, with healing time of (127.5±11.5) days on average. The Constant score increased significantly from (45.3±2.6) before surgery to(94.9±2.2) at the last follow-up. [Conclusion] This inverted L approach is convenient and feasible for the treatment of proximal humerusfracture with satisfactory early results.