Klonz A, Habermeyer P
ATOS-Praxisklinik GmbH&Co KG, Bismarckstrasse 9-15, 69115, Heidelberg, Germany.
Unfallchirurg. 2007 Oct;110(10):891-5. doi: 10.1007/s00113-007-1337-0.
Arthrodesis of the glenohumeral joint is a difficult intervention that involves a relatively high probability of complications. A stable internal fixation and secure consolidation is required. The operation needs to achieve several conditions: thorough denudation of the cartilage and partial decortication of the subchondral bone; good congruence of the corresponding surfaces; compression of the gap by tension screws and lasting stability. For increased primary stability a neutralizing plate is generally used as well as a compression screw. Up to now, the plate has usually been applied starting from the scapular spine and extending across the acromial corner to the humeral shaft. A wide exposure is needed for this procedure; the plate is difficult to shape during the operation and often causes some discomfort because it protrudes at the acromial corner. We present an alternative position of the plate in the supraspinatus fossa, where we have sited a 4.5 mm LCP locking plate (Synthes). The implant is inserted under the acromion, does not cause any discomfort at the acromial corner, and is far easier to shape. When it is used in association with a transarticular compressive screw, the technique results in a very stable situation, which allows physiotherapy from the first day after surgery onward.
肩关节融合术是一种难度较大的干预措施，并发症发生概率相对较高。需要稳定的内固定和可靠的骨愈合。该手术需满足几个条件：彻底剥脱软骨并对软骨下骨进行部分去皮质处理；相应表面良好的一致性；用拉力螺钉压缩间隙并保持持久稳定性。为提高初始稳定性，通常会使用中和钢板以及加压螺钉。到目前为止，钢板通常从肩胛冈开始应用，跨过肩峰角延伸至肱骨干。该手术需要广泛暴露；手术过程中钢板难以塑形，且因其在肩峰角处突出常引起一些不适。我们提出将钢板置于冈上肌窝的另一种位置，我们在此处放置了一块4.5毫米的锁定加压钢板（辛迪思公司）。植入物置于肩峰下方，不会在肩峰角处引起任何不适，且塑形要容易得多。当与经关节加压螺钉联合使用时，该技术可形成非常稳定的状态，术后第一天即可开始理疗。
