Jaeger M, Maier D, Izadpanah K, Südkamp N P
Klinik für Orthopädie und Unfallchirurgie, Department Chirurgie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
Oper Orthop Traumatol. 2017 Dec;29(6):492-508. doi: 10.1007/s00064-017-0521-9. Epub 2017 Oct 23.
Stabilization of the humerus with preservation or restoration of the shoulder function.
Always in the presence of a loose prosthesis. It may become necessary in conditions of poor bone stock and if osteosynthesis is not possible.
Noncompliant patients due to alcohol or drugs. Local infections.
The loose implant is removed using an extended anterior deltopectoral approach. After exploration of the fracture and extended soft tissue release, the glenoidal components are implanted with visualization and protection of the axillary nerve. A long stemmed implant is typically needed on the humeral side. It is anchored in the distal fragment over a length of about 6 cm. Soft tissue tension is crucial, especially with reverse shoulder arthroplasty.
Postoperatively, the affected limb is immobilized for 6 weeks on a 15° shoulder abduction pillow with active assisted movement therapy up to the horizontal plane. This is followed by gradual pain-adapted increases of movement, muscle coordination, and strength.
In 17 patients with periprosthetic fractures of the humerus surgically treated in our institution, 4 underwent revision arthroplasty because of a loose prosthesis. No intra- or postoperative complications were observed. All fractures healed except one.
稳定肱骨并保留或恢复肩部功能。
总是存在假体松动的情况。在骨量不足且无法进行骨合成的情况下可能有必要进行。
因酒精或药物而不配合治疗的患者。局部感染。
采用延长的前三角肌胸大肌入路取出松动的植入物。在探查骨折并进行广泛的软组织松解后，在可视化并保护腋神经的情况下植入关节盂组件。肱骨侧通常需要一个长柄植入物。它在远端骨折块中锚固约6厘米的长度。软组织张力至关重要，尤其是在反肩关节置换术中。
术后，患侧肢体在15°肩外展枕上固定6周，进行主动辅助运动治疗直至达到水平面。随后逐渐根据疼痛情况增加活动度、肌肉协调性和力量。
在我们机构接受手术治疗的17例肱骨假体周围骨折患者中，4例因假体松动接受了翻修关节置换术。未观察到术中或术后并发症。除1例骨折外，所有骨折均愈合。
