Cornell C N
Hospital for Special Surgery, New York, New York.
Orthop Rev. 1994 May;Suppl:19-23.
Many of the current techniques of internal fixation of proximal humerus fractures employ tension-band wires to achieve secure fixation, allowing immediate postoperative exercise of the affected limb. The addition of a cancellous lag screw placed from the humeral shaft into the humeral head may have several advantages. In particular, this lag screw does not violate the subacromial space and provides for impaction and initial stability between the head and shaft. The technique described herein has been used in 13 patients aged 54 to 86 years with two- and three-part fractures. This technique uses a deltopectoral approach with manual impaction of the humeral head and shaft. A 6.5-mm AO screw is used for lag-screw fixation, and two 18-gauge stainless steel wires are passed beneath the rotator cuff and secured to the shaft distally through drill holes. Passive range of motion of the involved shoulder is begun on postoperative day 1, and active range of motion and strengthening are allowed after the fourth postoperative week. Tension-band wiring combined with lag-screw fixation affords sufficient fracture stability to allow early, aggressive rehabilitation. As a method of internal fixation, this technique may have particular advantages in elderly patients with osteoporosis.
目前，许多肱骨近端骨折的内固定技术采用张力带钢丝来实现牢固固定，使患肢术后能立即进行活动。从肱骨干向肱骨头置入一枚松质骨拉力螺钉可能具有多种优势。特别是，这枚拉力螺钉不会侵犯肩峰下间隙，并能在肱骨头和肱骨干之间实现嵌插和初始稳定性。本文所述技术已应用于13例年龄在54至86岁的二部分和三部分骨折患者。该技术采用胸大肌三角肌入路，手动嵌插肱骨头和肱骨干。使用一枚6.5毫米的AO螺钉进行拉力螺钉固定，两根18号不锈钢丝从肩袖下方穿过，并通过钻孔在远端固定于肱骨干。术后第1天开始进行患侧肩部的被动活动度训练，术后第4周后允许进行主动活动度训练和力量训练。张力带钢丝联合拉力螺钉固定提供了足够的骨折稳定性，以允许早期积极康复。作为一种内固定方法，该技术在患有骨质疏松症的老年患者中可能具有特别的优势。
