The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus
The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus
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DOI：
10.1097/01.blo.0000152872.95806.09
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发表时间：
2005-05-01
影响因子：
4.2
通讯作者：
Lorich, DG
中科院分区：
文献类型：
--
作者：
Gardner, MJ;Griffith, MH;Lorich, DG
肱骨近端的外侧入路受到腋神经位置的限制。通过胸三角入路进行广泛的手术解剖可能会进一步破坏粉碎性骨折中剩余的脆弱血供。本研究的目的是探索一种直接的前外侧，微创入路肱骨近端。采用经三角肌缝前入路的肩峰前外侧扩大入路，解剖20例尸体肩关节。测量了腋神经的多个参数。在所有标本中，当神经离开四边形间隙时，神经都很容易触及，并且可以预见的是，神经被发现并保护在中缝深处，距离大结节隆起约35 mm。检查整个前神经发现，没有分支，除了主要的运动干穿过三角缝。随后，该入路用于16例肱骨近端骨折患者，无一例发生与手术入路相关的并发症。这种微创手术方法似乎是安全的，并可能是有用的治疗肱骨近端fracture.Level证据：治疗研究，IV级（病例系列，没有，或历史对照组）。有关证据等级的完整描述，请参见作者指南。
Lateral approaches to the proximal humerus have been limited by the position of the axillary nerve. Extensive surgical dissection through a deltopectoral approach may further damage the remaining tenuous blood supply in comminuted fractures. The purpose of our study was to explore a direct anterolateral, less invasive approach to the proximal humerus. Twenty cadaver shoulders were dissected using the extended anterolateral acromial approach through the anterior deltoid raphe. Multiple parameters were measured regarding the axillary nerve. The nerve was easily palpable in all specimens as it exited the quadrilateral space, and predictably was found and protected deep to the raphe, approximately 35 mm from the prominence of the greater tuberosity. Examination of the entire anterior nerve revealed that no branches besides the main motor trunk crossed the deltoid raphe. Subsequently, this approach was used in 16 patients with proximal humerus fractures, none of whom has had complications related to the surgical approach. This minimally invasive surgical approach seems to be safe, and may be useful in treating proximal humerus fractures.Level of Evidence: Therapeutic study, Level IV (case series-no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.