Lerch S, Berndt T, Lipka W, Rühmann O
Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Klinikum Agnes Karll Laatzen/Klinikum Region Hannover, Hildesheimer Str. 158, 30880, Laatzen, Deutschland.
Oper Orthop Traumatol. 2011 Jul;23(3):215-26. doi: 10.1007/s00064-011-0035-9.
The aim of the procedure is arthrodesis of the shoulder by osteosynthesis of the glenohumeral and the acromiohumeral joint each with three screws, which results in preservation of scapulothoracic motion and pain relief.
Traumatic brachial plexus lesions, palsy in infancy, poliomyelitis with preserved or restorable function of the elbow and the hand. Paralysis of the deltoid muscle and the rotator cuff. Nonrestorable vast defect of the rotator cuff with pseudoparalysis. Chronic infectious arthritis resistant to therapy. Unsuccessful attempts to treat glenohumeral instability. Alternative procedure to shoulder arthroplasty in young patients with omarthrosis, who perform hard physical work.
Insufficient strength of the scapular muscles (< grade 4, <75% of normal strength). Insufficient scapulothoracic passive motion. Inadequate soft tissue coverage after burns, excessive previous surgery or radiotherapy. Incomplete rehabilitation (<3 years) after neurosurgical interventions (neurolysis, nerve transplantation). Cases of resection of the proximal humerus.
Acampsia of the shoulder joint in 20° of abduction, 30° of anteversion, and 40° of internal rotation using three glenohumeral and three acromiohumeral spongiosa screws as a compression arthrodesis.
Thorax-arm-abduction splint (20° of abduction, 30° of anteversion, and 40° of internal rotation) until the week 6 postoperatively with removal for physiotherapy and personal hygiene. Assisted active and passive motion exercises for the elbow, hand, and fingers after the postoperative day 1. Weaning from the splint after the end of the week 6 postoperatively, full range of motion allowed.
In a prospective study from January 2007 to September 2008, 4 patients with a medium age of 35.7 years underwent screw arthrodesis of the shoulder with a follow-up of 1.0 (0.6-1.5) year. Primary fusion of all arthrodesis surfaces was achieved in all patients; no revision surgery was necessary. All patients improved in shoulder function with an average range of motion of 60° abduction and 40° anteversion.
该手术的目的是通过分别用三颗螺钉对盂肱关节和肩峰肱关节进行接骨术来实现肩关节融合，从而保留肩胛胸壁关节的活动并缓解疼痛。
创伤性臂丛神经损伤、婴儿期麻痹、肘部和手部功能保留或可恢复的小儿麻痹症。三角肌和肩袖麻痹。肩袖巨大不可修复缺损伴假性麻痹。对治疗有抵抗性的慢性感染性关节炎。治疗盂肱关节不稳的尝试失败。年轻患有全关节病且从事重体力劳动的患者，作为肩关节置换术的替代手术。
肩胛肌力量不足（<4级，<正常力量的75%）。肩胛胸壁被动活动不足。烧伤后软组织覆盖不足、既往手术过多或放疗。神经外科干预（神经松解术、神经移植）后康复不完全（<3年）。肱骨近端切除病例。
使用三颗盂肱和三颗肩峰肱松质骨螺钉作为加压融合术，在肩关节外展20°、前屈30°和内旋40°位进行肩关节固定。
术后佩戴胸臂外展夹板（外展20°、前屈30°和内旋40°）直至术后第6周，期间取下夹板进行物理治疗和个人卫生护理。术后第1天开始进行肘部、手部和手指的辅助主动和被动活动练习。术后第6周结束后逐渐停用夹板，允许进行全范围活动。
在2007年1月至2008年9月的一项前瞻性研究中，4名平均年龄为35.7岁的患者接受了肩关节螺钉融合术，随访时间为1.0（0.6 - 1.5）年。所有患者的所有融合面均实现了一期融合；无需翻修手术。所有患者的肩部功能均有改善，平均外展活动范围为60°，前屈活动范围为40°。
