Kwak Ji-Yong, Park Hyung-Bin, Jung Gu-Hee
Department of Orthopaedic Surgery, Gyeongsang National University, Changwon Gyeongsang national university Hospital, samjungda-dong, 111, 555, Chanwon, 642-160, Korea.
Arch Orthop Trauma Surg. 2016 Oct;136(10):1387-93. doi: 10.1007/s00402-016-2538-1. Epub 2016 Aug 4.
The purpose of this study was to identify the optimal position for a precontoured-locking plating (PHILOS(®)) of the proximal humerus in Asians in terms of conformity and to determine the prevalence of screw exits in the position of the highest conformity.
Twenty adult humeri and 14 cadaveric shoulders were included in this study. After placing the precontoured plate in the well-fitted position on the humerus, we measured the distance between the upper margin of the plate and the tip of greater tuberosity (GT) (distance A) and the distance between the anterior margin of the plate and lateral border of the bicipital groove (BG) (distance B). The prevalence of K-wire exits was assessed. In the 14 cadaver shoulders, the mutual relation between the most inferior locking sleeve of the optimally positioned plate and the axillary nerve was evaluated to assess the potential for axillary nerve injury.
The precontoured plate was well-fitted and remained in a relatively constant position in all specimens. Distance A was an average of 3.6 mm (range 1.4-5.5 mm), and distance B was an average of 2.5 mm (range 0-4.6 mm). The K wire closest to the BG pierced it in four cases (20 %), and most inferior K wires exited at an average distance of 3.8 mm (range 1.6-9.0 mm) from the inferior articular margin of the humeral head. Regarding involvement of the BG, articular width was the only significant variable in the logistic regression model, with an odds' ratio of 0.610. The axillary nerve was located at an average vertical distance of 59.7 mm (range 51.8-66.9 mm) from the tip of the GT in a vertically neutral position. The results did not differ between the left and right sides (t = 0.326, p = 0.755). Although the axillary nerve was slightly inferior to the most inferior locking holes of the proximal humerus, it was located in the path of their locking sleeves on the deltoid muscle.
The optimal position for the highest conformity led to ideal fixation of the proximal humerus and inferomedial support screw in Asians. However, the precontoured plate sometimes had screw exits that involved the BG, and articular width had a large impact on involvement of the BG. If locking sleeves for the most inferior holes were introduced on the deltoid muscle in a neutral position, there was high potential for injury to the axillary nerve in Koreans.
本研究旨在确定亚洲人肱骨近端预弯锁定钢板（PHILOS(®)）的最佳贴合位置，并确定在最高贴合位置时螺钉穿出的发生率。
本研究纳入了20具成人肱骨和14具尸体肩部标本。将预弯钢板置于肱骨上的合适位置后，测量钢板上缘与大结节（GT）尖端之间的距离（距离A）以及钢板前缘与肱二头肌沟（BG）外侧缘之间的距离（距离B）。评估克氏针穿出的发生率。在14具尸体肩部标本中，评估最佳位置钢板最下方锁定套筒与腋神经之间的相互关系，以评估腋神经损伤的可能性。
预弯钢板在所有标本中均贴合良好且位置相对恒定。距离A平均为3.6毫米（范围1.4 - 5.5毫米），距离B平均为2.5毫米（范围0 - 4.6毫米）。最靠近BG的克氏针在4例（20%）中穿出BG，最下方的克氏针从肱骨头下关节缘平均3.8毫米（范围1.6 - 9.0毫米）处穿出。关于BG的累及情况，关节宽度是逻辑回归模型中唯一的显著变量，优势比为0.610。在垂直中立位置，腋神经距GT尖端的平均垂直距离为59.7毫米（范围51.8 - 66.9毫米）。左右两侧结果无差异（t = 0.326, p = 0.755）。虽然腋神经略低于肱骨近端最下方的锁定孔，但它位于三角肌上其锁定套筒的路径上。
最高贴合度的最佳位置可实现亚洲人肱骨近端的理想固定和内下支撑螺钉固定。然而，预弯钢板有时会出现螺钉穿出累及BG的情况，且关节宽度对BG的累及有很大影响。如果在中立位置将最下方孔的锁定套筒置于三角肌上，韩国人腋神经损伤的可能性很高。
