Bhatia Deepak N
Seth GS Medical College, and King Edward VII Memorial Hospital, Mumbai, India.
Arthrosc Tech. 2017 Mar 27;6(2):e375-e381. doi: 10.1016/j.eats.2016.10.014. eCollection 2017 Apr.
Proximal humerus fracture fixation may be complicated by persistent postsurgical stiffness or implant-related problems. Arthroscopic plate removal is a cosmetic and functionally beneficial procedure; however, the procedure is technically difficult in the presence of severe subdeltoid scarring. The technique described here shows an arthroscopic subdeltoid adhesiolysis and proximal humerus plate removal using systematic access to 5 regions of screw positions on the plate. After initial glenohumeral adhesiolysis, a thorough subacromial and subdeltoid bursectomy is performed. The axillary nerve and deltoid are retracted via an anterosuperolateral portal, and a posterolateral portal is used for panoramic viewing along the plate length. Lateral portals are placed above and below the axillary nerve, and these are used for screw removal. Finally, the plate is removed via a 1-inch incision along the previous surgical scar. The technique is cosmetic and minimally invasive, and early rehabilitation restores range of motion and strength. Technical tips for safe dissection in the scarred subdeltoid space and guidelines for protection of neurovascular structures are presented.
肱骨近端骨折固定可能会因术后持续僵硬或植入物相关问题而变得复杂。关节镜下钢板取出术是一种具有美容效果且对功能有益的手术；然而，在存在严重三角肌下瘢痕形成的情况下，该手术在技术上具有挑战性。本文所述技术展示了一种关节镜下三角肌下粘连松解术及肱骨近端钢板取出术，该方法通过系统地进入钢板上5个螺钉位置区域来进行操作。在最初的盂肱关节粘连松解术后，进行彻底的肩峰下和三角肌下滑囊切除术。通过前上外侧入路牵开腋神经和三角肌，使用后外侧入路沿钢板长度进行全景观察。在腋神经上方和下方放置外侧入路，用于取出螺钉。最后，通过沿先前手术瘢痕的1英寸切口取出钢板。该技术具有美容效果且微创，早期康复可恢复活动范围和力量。文中还介绍了在瘢痕化的三角肌下间隙进行安全解剖的技术要点以及保护神经血管结构的指南。
