Gill D R, Torchia M E
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Orthop Trauma. 1999 Feb;13(2):141-4. doi: 10.1097/00005131-199902000-00013.
We present a case of humeral nonunion managed with a dynamic compression plate (DCP) contoured in a spiral fashion to preserve the deltoid muscle insertion. A forty-one-year-old woman sustained a closed proximal third humeral shaft fracture with an associated supraclavicular brachial plexus injury. She presented five months later with an atrophic nonunion of the proximal humeral shaft, inferior subluxation of the humeral head, and a resolving brachial plexopathy. Autogenous cancellous bone grafting and open reduction and internal fixation with a narrow DCP was performed. The deltoid muscle insertion was preserved by contouring the plate to fix the proximal humerus laterally over the greater tuberosity and anteriorly over the mid-humeral shaft. During the postoperative period, the humeral head reduced spontaneously. Five months after surgery, the fracture healed, and an excellent clinical result was achieved. We recommend the use of the spiral DCP for proximal shaft fractures and nonunions when preservation of the deltoid insertion is desirable.
我们报告一例采用螺旋塑形动力加压钢板（DCP）治疗的肱骨骨不连病例，该塑形方式可保留三角肌止点。一名41岁女性遭受闭合性肱骨近端三分之一骨干骨折，伴有锁骨上臂丛神经损伤。五个月后，她出现肱骨近端骨干萎缩性骨不连、肱骨头向下半脱位以及正在恢复的臂丛神经病变。遂行自体松质骨移植以及使用窄动力加压钢板进行切开复位内固定术。通过将钢板塑形，使其在大结节外侧及肱骨干中部前方固定肱骨近端，从而保留了三角肌止点。术后，肱骨头自行复位。术后五个月，骨折愈合，取得了优异的临床效果。我们建议，当需要保留三角肌止点时，可使用螺旋动力加压钢板治疗肱骨近端骨干骨折及骨不连。
