AO Research Institute Davos, Davos, Switzerland.
Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):411-418. doi: 10.1007/s00068-022-02082-y. Epub 2022 Aug 20.
Helical plates are preferably used for proximal humeral shaft fracture fixation and potentially avoid radial nerve irritation.
Safety of applying four different long plate designs (straight, 45°-, 90°-helical and ALPS) with MIPO technique as well as assessment and comparison of their distances to adjacent anatomical structures.
MIPO was performed in 16 human cadaveric humeri using either a straight (group 1), a 45°-helical (group 2), a 90°-helical (group 3) plate, or an ALPS (group 4). Applying CT angiography, distances between brachial arteries and plates were evaluated. All specimens were dissected and distances to the axillary, radial and musculocutaneous nerve were evaluated.
No specimens demonstrated injuries of the anatomical structures at risk after MIPO with all investigated plate designs. Closest overall distance (mean (range); mm) between each plate and the radial nerve was 1 (1-3) in group 1, 7 (2-11) in group 2, 14 (7-25) in group 3 and 6 (3-8) in group 4. It was significantly bigger in group 3 and significantly smaller in group 1 compared to all other groups, p < 0.001. Closest overall distance between each plate and the musculocutaneous nerve was 16 (8-28) in group 1, 11 (7-18) in group 2, 3 (2-4) in group 3 and 6 (3-8) in group 4. It was significantly bigger in group 1 and significantly smaller in group 3 compared to all other groups, p < 0.001.
MIPO with 45°- and 90°-helical plates as well as with ALPS is safely feasible and demonstrates significantly bigger distances to the radial nerve compared to straight plates. However, the distances remain small and attention must be paid to the musculocutaneous nerve and the brachial artery when MIPO is applied using ALPS, 45°- and 90°-helical implants.
螺旋钢板更适合用于肱骨近端干骨折固定，并且可能避免桡神经刺激。
应用四种不同的长钢板设计（直型、45°-螺旋型、90°-螺旋型和 ALPS）进行微创钢板内固定术（MIPO）的安全性，以及评估和比较它们与相邻解剖结构的距离。
在 16 个人体肱骨标本中使用直型钢板（第 1 组）、45°-螺旋型钢板（第 2 组）、90°-螺旋型钢板（第 3 组）或 ALPS 钢板（第 4 组）进行 MIPO。应用 CT 血管造影评估肱动脉与钢板之间的距离。所有标本均进行解剖，并评估与腋神经、桡神经和肌皮神经的距离。
所有研究的钢板设计均未在 MIPO 后导致有风险的解剖结构损伤。每组钢板与桡神经的整体最近距离（均值（范围）；mm）分别为：第 1 组 1（1-3），第 2 组 7（2-11），第 3 组 14（7-25），第 4 组 6（3-8）。第 3 组明显大于第 1 组和其他所有组，第 1 组明显小于其他所有组，差异均具有统计学意义（p<0.001）。每组钢板与肌皮神经的整体最近距离分别为：第 1 组 16（8-28），第 2 组 11（7-18），第 3 组 3（2-4），第 4 组 6（3-8）。第 1 组明显大于其他所有组，第 3 组明显小于其他所有组，差异均具有统计学意义（p<0.001）。
MIPO 应用 45°-和 90°-螺旋钢板以及 ALPS 是安全可行的，与直钢板相比，其与桡神经的距离明显更大。然而，当使用 ALPS、45°-和 90°-螺旋植入物进行 MIPO 时，与桡神经的距离仍然较小，必须注意肌皮神经和肱动脉。
