Levy Ofer
Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire RG1 5AN, United Kingdom. E-mail address:
JBJS Essent Surg Tech. 2014 Jun 25;4(2):e12. doi: 10.2106/JBJS.ST.M.00049. eCollection 2014 Jun.
This article describes our technique of thoracoscapular fusion with screw fixation for treatment of winging of the scapula in patients with fascioscapulohumeral dystrophy.
STEP 1 PREOPERATIVE EVALUATION: Perform the Horwitz test.
STEP 2 POSITION THE PATIENT AND MARK THE SKIN FOR THE OPERATION: With the patient on a Montreal mattress, position the arms in 90° to 110° of elevation in the scapular plane and approximately 90° of external rotation and mark the skin.
STEP 3 SURGICAL APPROACH: Make an incision along the medial scapular edge, incise the trapezius muscle, and detach the levator scapula, rhomboid major, and rhomboid minor muscles.
STEP 4 PREPARE THE SCAPULA: Do not decorticate the scapula to avoid weakening it.
STEP 5 SELECT AND PREPARE THE RIBS: Expose three or four ribs subperiosteally, from their superior border to avoid the neurovascular bundle.
STEP 6 DRILL THE SCAPULA AND RIBS: Drill the ribs with a McDonald dissector underneath them to prevent damage to the pleura.
STEP 7 HARVEST AND INTRODUCE BONE GRAFT OR USE BONE-GRAFT SUBSTITUTE AND CLOSE: Pack bone chips or bone-graft substitute between the ribs and the deep surface of the scapula.
STEP 8 POSTOPERATIVE IMMOBILIZATION AND REHABILITATION: An adjustable brace with the arm in 60° of abduction and 30° of forward flexion is worn for three months.
Between July 1997 and July 2010, a thoracoscapular fusion was performed in thirty-five shoulders of twenty-four patients with fascioscapulohumeral dystrophy.IndicationsContraindicationsPitfalls & Challenges.
本文介绍了我们采用螺钉固定进行胸肩胛融合术治疗面肩肱型肌营养不良患者肩胛翼状畸形的技术。
步骤1 术前评估：进行霍维茨试验。
步骤2 患者体位及手术皮肤标记：患者置于蒙特利尔床垫上，将手臂置于肩胛平面抬高90°至110°且外旋约90°的位置，并标记皮肤。
步骤3 手术入路：沿肩胛内侧缘做切口，切开斜方肌，分离肩胛提肌、大菱形肌和小菱形肌。
步骤4 肩胛准备：不要对肩胛进行去皮质处理以避免削弱其强度。
步骤5 肋骨选择与准备：在骨膜下暴露三或四根肋骨，从其上缘开始以避免损伤神经血管束。
步骤6 肩胛和肋骨钻孔：在肋骨下方用麦克唐纳剥离器钻孔以防止损伤胸膜。
步骤7 采集并植入骨移植材料或使用骨移植替代物并关闭切口：在肋骨与肩胛深面之间填充骨屑或骨移植替代物。
步骤8 术后固定与康复：佩戴可调节支具，手臂外展60°、前屈30°，持续三个月。
1997年7月至2010年7月，对24例面肩肱型肌营养不良患者的35个肩部进行了胸肩胛融合术。适应证、禁忌证、陷阱与挑战。
