Harper G D, Gunther S B, Sonnabend D H
Consultant Orthopaedic Surgeon, QA Hospital, Cosham, PO6 3LY, Portsmouth, UK.
Department of Orthopaedics and Trauma, Prince of Wales Hospital, Sydney, Australien.
Oper Orthop Traumatol. 1999 Sep;11(3):162-72. doi: 10.1007/BF02593977.
Stabilization of the glenohumeral joint to relieve pain and to improve function in instances of muscle paralysis secondary to plexus palsy, destruction of the joint with massive bone loss and large irreparable cuff tears.
Paralysis of the rotator cuff or deltoid muscles secondary to brachial plexus lesions or polio. Severe joint degeneration following infection. Massive irreparable cuff tears. Failed arthroplasty. Severe rheumatoid disease.
Advanced arthritis of the ipsilateral elbow. Arthroplasty of the ipsilateral elbow. Extensive loss of scapulothoracic muscles. Severe thoracic scoliosis and advanced arthritis of the sternoclavicular and acromioclavicular joints are relative contraindications.
Anterolateral lazy S-incision. Retraction of deltoid. Osteotomy of the lateral acromion. Exposure and denuding of humeral and glenoid articular surfaces. Freshening of the undersurface of the acromion. Internal fixation with an 8- to 10-hole pelvic reconstruction plate in a position of 20 to 40° of abduction, 20 to 40° of flexion and 30 to 50° of internal rotation. Apposition of acromion. Postoperative immobilization for a period of at least 6 weeks on a splint prepared before surgery. This splint allows early mobilization of the elbow.
Report on 60 shoulder arthrodeses (42 men, 18 women, average age 28 years, average length of follow-up 4 years). Plate loosening was observed 5 times, leading to a nonunion in 2 patients. A fracture beneath the plate occurred twice, in 5 patients the pain relief was not satisfactory. Revision became necessary in 2 patients due to poor position of the transglenoid screw. The time to union calculated in 49 patients amounted to an average of 7.9 months, in general union took longer following a failed arthroplasty and was shortest after brachial plexus palsy.
稳定盂肱关节，以缓解因臂丛神经麻痹继发的肌肉麻痹、伴有大量骨质流失的关节破坏以及不可修复的巨大肩袖撕裂等情况引起的疼痛并改善功能。
臂丛神经损伤或小儿麻痹后遗症导致的肩袖或三角肌麻痹。感染后严重的关节退变。不可修复的巨大肩袖撕裂。关节置换术失败。严重的类风湿性疾病。
同侧肘关节晚期关节炎。同侧肘关节置换术。肩胛胸壁肌肉广泛缺失。严重的胸椎侧弯以及胸锁关节和肩锁关节晚期关节炎为相对禁忌证。
前外侧“L”形切口。牵开三角肌。肩峰外侧截骨。暴露并去除肱骨和关节盂的关节面。修整肩峰下表面。在肩关节外展20至40°、屈曲20至40°以及内旋30至50°的位置用一块8至10孔的骨盆重建钢板进行内固定。对合肩峰。术后用术前准备好的夹板固定至少6周。该夹板可使肘关节早期活动。
报告了60例肩关节融合术（男性42例，女性18例，平均年龄28岁，平均随访时间4年）。观察到5次钢板松动，导致2例骨不连。钢板下方发生骨折2次，5例患者疼痛缓解不令人满意。2例患者因经关节盂螺钉位置不佳需要翻修。49例患者的愈合时间平均为7.9个月，一般来说，关节置换术失败后愈合时间更长，臂丛神经麻痹后最短。
