Albert Sandeep, Inja Dan Barnabas, Arunachalam Eswar, Cherian Vinoo Mathew
Department of Orthopaedics Unit-1, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
JSES Rev Rep Tech. 2021 Jun 30;1(4):421-425. doi: 10.1016/j.xrrt.2021.05.004. eCollection 2021 Nov.
The posterior approach to the humeral shaft is commonly used for surgical procedures on the humeral shaft. We present our experiences using the modification of the surgical exposure described by Gerwin M. which we have found useful at the time of revision surgery.
Between 2014 and 2019, six patients who underwent a revision surgical procedure for a nonunion of the humeral shaft where a prior surgical procedure was performed through a posterior incision were included. The approach used a modification of the posterior approach described by Gerwin M. where the lower lateral cutaneous nerve branch of the radial nerve is used to identify trace, mobilize, retract, and protect the radial nerve to achieve adequate exposure of the humeral shaft.
None of the patients had a postoperative nerve deficit.Adequate exposure to aid hardware removal, osteosynthesis, and bone grafting was achieved in all patients.
The modification of the posterior approach described by Gerwin M. is useful at the time of revision or redo surgery on the humeral shaft where other bony and soft tissue landmarks are altered to prevent an iatrogenic injury to the radial nerve while providing adequate exposure to treat a nonunion.
肱骨干后路常用于肱骨干的外科手术。我们介绍了采用Gerwin M.所描述的手术显露改良方法的经验，我们发现在翻修手术时该方法很有用。
2014年至2019年期间，纳入了6例因肱骨干骨不连接受翻修手术的患者，这些患者之前的手术是通过后外侧切口进行的。该入路采用了Gerwin M.所描述的后外侧入路的改良方法，即利用桡神经的下外侧皮神经分支来识别、追踪、游离、牵开并保护桡神经，以充分显露肱骨干。
所有患者术后均无神经功能缺损。所有患者均获得了足够的显露，有助于取出内固定物、进行骨固定和植骨。
Gerwin M.所描述的后外侧入路改良方法在肱骨干翻修手术或再次手术时很有用，此时其他骨骼和软组织标志已改变，可防止桡神经医源性损伤，同时提供足够的显露以治疗骨不连。
