Waszczykowski Michał, Fabiś Jarosław
Department of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology, Medical University of Lodz, Lodz, Poland, ul. Żeromskiego 113, 90-549, Lodz, Poland.
FMC Medical Center, 9A Piłsudskiego, Lodz, Poland.
BMC Musculoskelet Disord. 2020 Sep 22;21(1):625. doi: 10.1186/s12891-020-03634-2.
The deltopectoral approach is commonly used for plate stabilization of proximal humerus fracture. Although adhesions between the deltoid, plate, and humerus are common sequelae of plate ORIF, little is known about their effect on the range of movement and a function of the shoulder. To confirm their impact, the preoperative and intraoperative evaluation of the range of motion (ROM) was measured during the sequential arthroscopic release of adhesions, with special regard to external rotation. Postoperative ROM and subjective shoulder function were also evaluated.
Eighteen patients treated with ORIF of the proximal humerus were scheduled to the unified arthroscopic procedures comprising sequential limited subacromial bursectomy, removal of the adhesions between the deltoid, plate, and humerus, as well as the plate removal. The ROM of the operated and opposite shoulders were assessed before surgery, intraoperatively and after a minimum two-year follow-up, with special regard to external rotation in adduction (AddER) and abduction (AbdER). Besides, the Constant-Murley score and Subjective Shoulder Value (SSV) were evaluated before a plate removal and after a minimum two-year follow-up after the surgery.
Deltoid adhesion release correlated with considerable and statistically significant improvement of AddER (p < 0.0002) but not with the intraoperative range of AbdER. Significant improvement of AddER, but also of AbdER and other range of motion was noted at the follow-up. The improvement of the affected shoulder function following arthroscopic plate removal was considerable and statistically significant according to the modified Constant-Murley score (p < 0,01) and SSV (p < 0.0000) after a minimum of two-year follow-up.
Our findings are the first to highlight the influence of deltoid muscle, plate, and humerus adhesions on limiting external rotation in adduction after ORIF treatment of proximal humerus fractures. These observations allow the identification of a new shoulder evaluation symptom: Selective Glenohumeral External Rotation Deficit (SGERD) as well as functional deltohumeral space.
三角肌胸大肌入路常用于肱骨近端骨折的钢板固定。虽然三角肌、钢板和肱骨之间的粘连是钢板切开复位内固定（ORIF）常见的后遗症，但关于它们对肩关节活动范围和功能的影响却知之甚少。为证实其影响，在关节镜下依次松解粘连的过程中测量了术前和术中的活动范围（ROM），特别关注外旋情况。还评估了术后的ROM和主观肩关节功能。
18例接受肱骨近端ORIF治疗的患者接受了统一的关节镜手术，包括依次进行有限的肩峰下滑囊切除术、松解三角肌、钢板和肱骨之间的粘连以及取出钢板。在手术前、术中以及至少两年的随访后，评估患侧和对侧肩关节的ROM，特别关注内收位（AddER）和外展位（AbdER）的外旋情况。此外，在取出钢板前以及手术后至少两年的随访后，评估Constant-Murley评分和主观肩关节值（SSV）。
三角肌粘连松解与AddER有显著且具有统计学意义的改善相关（p < 0.0002），但与术中AbdER的活动范围无关。随访时AddER有显著改善，AbdER和其他活动范围也有显著改善。根据改良的Constant-Murley评分（p < 0.01）和SSV（p < 0.0000），在至少两年的随访后，关节镜下取出钢板后患侧肩关节功能有显著且具有统计学意义的改善。
我们的研究结果首次强调了三角肌、钢板和肱骨之间的粘连对肱骨近端骨折ORIF治疗后内收位外旋受限的影响。这些观察结果有助于识别一种新的肩关节评估症状：选择性肱骨头外旋缺损（SGERD）以及功能性三角肌肱骨间隙。
