Smith Jason, Berry Greg, Laflamme Yves, Blain-Pare Etienne, Reindl Rudy, Harvey Edward
Department of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada.
Injury. 2007 Feb;38(2):206-11. doi: 10.1016/j.injury.2006.08.025. Epub 2006 Oct 25.
This cadaveric study sought to evaluate the feasibility of applying a locking proximal humerus plate with a novel minimally invasive technique. A unique pre-contoured locking plate was placed on cadaveric proximal humeri through a described minimally invasive approach. Proximity of the plate and screws to the axillary nerve and their respective surgical tracks were quantified. Safe screw hole placement with respect to the axillary nerve was determined. Risk of entrapment of the nerve beneath the plate was evaluated. Three of the holes near the middle of the locking plate consistently intersected the course of the axillary nerve and were unsafe for percutaneous placement of the screws. The axillary nerve could be palpated during the course of surgery and easily protected from injury. No entrapment of the axillary nerve occurred using this minimally invasive technique. The screw-in locking guide cannot be used with this technique as it caused tenting of the axillary nerve. Placement of a locking proximal humerus plate via a minimally invasive lateral trans-deltoid approach is safe if the locking screws are limited to superior and inferior holes. This can be done safely without entrapment of the axillary beneath the plate. Plate fixation of proximal humerus fractures may now be more desirable with the use of this approach.
这项尸体研究旨在评估采用一种新型微创技术应用锁定肱骨近端钢板的可行性。通过一种描述的微创方法，将一块独特的预塑形锁定钢板放置在尸体肱骨近端。对钢板和螺钉与腋神经的接近程度及其各自的手术路径进行了量化。确定了相对于腋神经的安全螺钉孔位置。评估了神经被钢板下方卡压的风险。锁定钢板中部附近的三个孔始终与腋神经走行相交，经皮放置螺钉不安全。在手术过程中可触及腋神经，且能轻松保护其免受损伤。使用这种微创技术未发生腋神经卡压。由于该技术会导致腋神经起皱，因此不能使用拧入式锁定导向器。如果锁定螺钉仅限于上方和下方的孔，则通过微创外侧经三角肌入路放置锁定肱骨近端钢板是安全的。这样做可安全进行，且不会使腋神经被钢板下方卡压。使用这种方法，现在肱骨近端骨折的钢板固定可能更可取。
