Gurhan Utku, Ozgur Yildirim Ahmet, Alper Yavuz Ibrahim, Gul Yurdakul Fatma, Civgin Esra, Erler Kaan, Ceyhan Erman, Sivas Filiz
Department of Orthopaedic Surgery, University of Kyrenia, KKTC Kyrenia, Mersin 10, Turkey.
Department of Orthopedic Surgery, Health Sciences University Ankara City Hospital Üniversiteler, 06800, Çankaya/Ankara, Turkey.
J Orthop. 2022 Jul 12;33:81-86. doi: 10.1016/j.jor.2022.07.005. eCollection 2022 Sep-Oct.
The clinical effects of axillary nerve injury in the deltoid splitting approach are controversial. This study investigated the axillary nerve function with clinical and electrophysiologically in proximal humeral fracture patients with internal fixation using the deltoid split approach. We also aimed to investigate the effects of this damage on deltoid muscle volume and discuss the effects of volumetric changes and nerve damage on patients' clinical outcomes.
study designed prospectively with 25 consecutive patients who received open reduction and internal fixation of proximal humerus fracture through a deltoid splitting approach. We performed clinical, electrophysiological, and radiological examinations during minimum follow-up time of 24 months. Electrophysiological examination comprised electromyoneurography (EMNG). Functional results followed by Constant-Murley and Disabilities of the Arm, Shoulder, and Hand scores. Deltoid volumes were evaluated with magnetic resonance imaging.
Twenty-five patients operated on with open reduction internal fixation were prospectively observed. In the EMNG measurements of the patients on the 45th postoperative day, partial degeneration was observed in the anterior part of the axillary nerve in all cases (100%). In the control EMNG measurements performed at the 12th month, normal values were obtained for 15 (60%) of the patients, while findings of ongoing regeneration were detected for 10 (40%) of the patients and normal values at all patients at the 24th month. The difference between abnormal and normal EMNG groups' on 12th month Constant-Murley scores was not statistically significant in any period. Only anterior muscle thickness was statistically higher in the normal patient group than with abnormal EMNG results.
In proximal humeral fractures treated with the deltoid split approach, there may be iatrogenic damage of the anterior branch of the axillary nerve. Axillary nerve damage does not affect the patients' clinical scores in the early and mid-terms.
LEVEL III.
在三角肌劈开入路中腋神经损伤的临床效果存在争议。本研究采用临床和电生理方法，对采用三角肌劈开入路进行肱骨近端骨折内固定的患者的腋神经功能进行了研究。我们还旨在研究这种损伤对三角肌体积的影响，并讨论体积变化和神经损伤对患者临床结局的影响。
本研究为前瞻性设计，纳入25例连续接受经三角肌劈开入路肱骨近端骨折切开复位内固定术的患者。在至少24个月的最短随访期内，我们进行了临床、电生理和影像学检查。电生理检查包括肌电图神经电图（EMNG）。功能结果采用Constant-Murley评分和手臂、肩部和手部残疾评分。采用磁共振成像评估三角肌体积。
前瞻性观察了25例行切开复位内固定术的患者。在术后第45天对患者进行的EMNG测量中，所有病例（100%）的腋神经前部均观察到部分变性。在第12个月进行的对照EMNG测量中，15例（60%）患者获得正常值，10例（40%）患者检测到持续再生的结果，而在第24个月时所有患者均为正常值。在任何时期，异常和正常EMNG组在第12个月的Constant-Murley评分之间的差异均无统计学意义。仅正常患者组的前肌厚度在统计学上高于EMNG结果异常的患者。
在采用三角肌劈开入路治疗的肱骨近端骨折中，可能存在腋神经前支的医源性损伤。腋神经损伤在早期和中期不影响患者临床评分。
III级。
