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  

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

作　　者：刘磊[1] 张盘军[1] 蒋建农[1] 司刚[1] 周鸣[1] 王勇[1] 陈文钧[2] 莫渊[1] 

机构地区：[1]宜兴市人民医院骨科,无锡214200 [2]复旦大学附属华山医院骨科,上海200040

出　　处：《第二军医大学学报》2015年第12期1344-1347,共4页Academic Journal of Second Military Medical University

摘　　要：目的探讨经肩峰下前外侧入路（anterolateral acromial approach,ALA入路）微创治疗严重外展嵌插型肱骨近端骨折的可行性及临床疗效。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例患者均获得1年以上随访,平均（15±3）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个月随访时Constant-Murley功能评分平均为（83.0±1.5）分（79.0-89.5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,能避免神经、血管损伤,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。Objective To evaluate the feasibility and clinical outcomes of minimally invasive treatment via anterolateral acromial approach（ALA）for severely impacted valgus fractures of the proximal part of the humerus.Methods From June2011 to May 2013,a total of 20 patients with severely impacted valgus proximal humeral fracture were treated through ALA in a minimally invasive manner.Direct reduction,bone grafting,reconstruction of the rotator cuff insertion and Proximal Humerus Internal Locking System（PHILOS）planting were well carried out.Systematic rehabilitation exercise of the shoulder joint was performed postoperatively.Results All the patients were followed-up for at least one year,with an average of（15±3）months（range 12-36months）.No axillary neurapraxia occurred that could be attributed to the surgical approach.All fractures healed within 6months,and the average Constant-Murley score at 1year was（83.0±1.5）（range 79.0to 89.5）during a 12-month follow-up.There was no internal fixation failure or avascular necrosis（AVN）of humeral head during follow-up.Conclusion Treatment of severely impacted valgus proximal humeral fractures with minimally invasive ALA through percutaneous plating PHILOS can avoid the injury of nerve and vascular,reduce the dissection of soft tissue,avoid damage to the residual blood supply of the humeral head and achieve stable fixation,benefiting early function recovery.

关 键 词：肱骨骨折 微创性外科手术 骨折固定术 肩峰下前外侧入路 

分 类 号：R683.413[医药卫生—骨科学]