Johnson N A, Pandey R
Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK.
Shoulder Elbow. 2019 Oct;11(5):353-358. doi: 10.1177/1758573218791815. Epub 2018 Aug 8.
We describe a minimally open reduction and percutaneous fixation technique for three- and four-part proximal humeral fracture-dislocations which preserves soft tissues.
Eleven consecutive patients with three-and four-part proximal humeral fracture-dislocations (eight anterior, three posterior dislocations) were treated this way. The dislocation is reduced using a mini-open deltopectoral approach with a horizontal split in subscapularis. Fracture fragments are fixed with percutaneous screws. Constant and Oxford Shoulder Score were collected prospectively.
Mean age was 51 years (range 32-65). Mean follow-up was 36 months (range 24-72 months). At last follow-up mean Constant score was 75 (range 64-86) compared to 88 (range 85-92) for the uninjured shoulder. Mean Oxford shoulder score was 41 (range 34-46). One patient developed avascular necrosis. Screw back out was seen in three patients. These were removed under local anaesthesia. There were no screw penetrations of articular surface. One patient suffered a radial nerve neuropraxia which resolved.
These results are promising and comparable to published literature with other means of fixation for this complex problem. Due to minimal soft tissue dissection the complications rate is low.
我们描述了一种用于治疗三部分和四部分肱骨近端骨折脱位的微创切开复位和经皮固定技术，该技术可保留软组织。
连续11例三部分和四部分肱骨近端骨折脱位患者（8例前脱位，3例后脱位）接受了这种治疗。通过采用小切口胸大肌三角肌入路并在肩胛下肌进行水平劈开的方式来复位脱位。骨折碎片用经皮螺钉固定。前瞻性收集Constant和牛津肩部评分。
平均年龄为51岁（范围32 - 65岁）。平均随访时间为36个月（范围24 - 72个月）。在最后一次随访时，平均Constant评分为75分（范围64 - 86分），而未受伤肩部的评分为88分（范围85 - 92分）。平均牛津肩部评分为41分（范围34 - 46分）。1例患者发生了缺血性坏死。3例患者出现螺钉退出情况，在局部麻醉下将其取出。没有螺钉穿破关节面的情况。1例患者发生桡神经失用，随后恢复。
这些结果很有前景，与已发表的关于该复杂问题的其他固定方法的文献结果相当。由于软组织剥离最少，并发症发生率较低。
