Department of Trauma Hand and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Arch Orthop Trauma Surg. 2023 Aug;143(8):4993-5000. doi: 10.1007/s00402-023-04820-2. Epub 2023 Mar 6.
Proximal humerus fractures are common and often associated with osteoporosis in the elderly. Unfortunately, the complication and revision rate for joint-preserving surgical treatment using locking plate osteosynthesis is still high. Problems include insufficient fracture reduction and implant misplacement. Using conventional intraoperative two dimensional (2D) X-ray imaging control in only two planes, a completely error-free assessment is not possible.
The feasibility of intraoperative three-dimensional (3D) imaging control for locking plate osteosynthesis with screw tip cement augmentation of proximal humerus fractures was retrospectively studied in 14 cases with an isocentric mobile C-arm image intensifier set up parasagittal to the patients.
The intraoperative digital volume tomography (DVT) scans were feasible in all cases and showed excellent image quality. One patient showed inadequate fracture reduction in the imaging control, which then could be corrected. In another patient, a protruding head screw was detected, which could be replaced before augmentation. Cement distribution in the humeral head was consistent around the screw tips with no leakage into the joint.
This study shows that insufficient fracture reduction and implant misplacement can be easily and reliably detected by intraoperative DVT scan with an isocentric mobile C-arm set up in the usual parasagittal position to the patient.
肱骨近端骨折很常见，且常与老年人骨质疏松症有关。不幸的是，使用锁定钢板内固定术进行保关节手术治疗的并发症和翻修率仍然很高。问题包括骨折复位不足和植入物错位。术中仅使用二维（2D）X 射线成像控制在两个平面上，无法进行完全无误差的评估。
我们回顾性研究了 14 例采用与患者矢状面成角设置的等中心移动 C 臂影像增强器进行肱骨近端骨折锁定钢板内固定术中三维（3D）成像控制的可行性。术中数字断层扫描（DVT）扫描在所有病例中均可行，图像质量良好。1 例患者在影像学控制下显示骨折复位不足，随后进行了纠正。另 1 例患者发现突出的头钉，在增强前可以更换。骨水泥在肱骨头内的分布围绕钉尖一致，没有进入关节。
本研究表明，术中通过与患者矢状面成角设置的等中心移动 C 臂进行 DVT 扫描，可轻松、可靠地检测到骨折复位不足和植入物错位。
