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
焦录 1贾建新 1马云强 1段文禹 1强茂昌 1周东明2
作者信息
- 1. 内蒙古科技大学包头医学院,内蒙古包头 014010
- 2. 内蒙古科技大学包头医学院第一附属医院,内蒙古包头 014010
- 折叠
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4 cm,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)cm2 vs(15.1±3.7)cm2 vs(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 and the preliminary clinical results.[Method]From June 2021 to June 2022,20 patients with proximal humeral fractures were treated through an inverted"L"approach.A horizontal skin incisions were extended along the acromial process from the anterolateral to the posterolateral border.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,the exposed area was identified.As the bone fragments and blood clots were removed,the fracture was reduced,were temporarily immobilized with 2 Kirschner wires,and then fixed by PHILOS plate.[Results]The exposed areas measured in the cadaveric specimens were ranked as inverted"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].All patients 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 the operation,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 humerus fracture with satisfactory early results.
关键词
肱骨近端骨折/倒L形入路/三角肌劈开入路/胸三角肌入路/暴露面积Key words
proximal humerus fracture/inverted L-shaped approach/deltoid split approach/pectodeltoid approach/exposed area引用本文复制引用
出版年
2024
NETL
NSTL
万方数据