首页 | 本学科首页   官方微博 | 高级检索  
     


Proximal humerus exposure with the inverted-L anterolateral deltoid flip approach,anterolateral deltoid splitting approach,and deltopectoral approach: A comparative cadaveric study
Affiliation:1. Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;2. Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand;3. Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Thailand;1. University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management;2. University of North Carolina at Chapel Hill, School of Medicine, Department of Surgery, 4008 Burnett Womack Building, CB 7228, United States;3. Department of Orthopedics, Haukeland University, Bergen, Norway;4. Department of Surgery, Kamuzu Central Hospital, Malawi;1. Graduate Program in Surgery and Translational Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil;2. Department of Structural and Functional Biology (Anatomy Sector), Institute of Biosciences, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil;3. Center for the Studies of Venoms and Venomous Animals (CEVAP), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil;4. Herminio Ometto University Center (Uniararas), Araras, São Paulo, Brazil;1. Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou 310006, China;2. Department of Endocrinology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou 310006, China;3. Department of Orthopaedics, Affiliated Cixi Hospital of Wenzhou Medical University, Cixi, China;1. University of Calgary, Section of Orthopaedics, Department of Surgery, Foothills Medical Center, 29th St. NW, Calgary, Alberta T2N 5A1, Canada;2. University of British Columbia, Department of Orthopaedics, Faculty of Medicine, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia V5Z 1M9, Canada;3. University of Calgary, 0490 McCaig Tower, Foothills Medical Center, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1, Canada;1. King''s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King''s College London, London, UK;2. Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK;3. Karonga District Hospital, Karonga District Health Office, Karonga, Malawi;4. Mzuzu Central Hospital, Department of Orthopaedic Surgery, Mzuzu, Malawi;5. Malawi Epidemiology and Intervention Research Unit (MEIRU), Chilumba, Karonga District Malawi;6. Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK;7. Centre for Applied Health Research, University of Birmingham, Birmingham, UK;8. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa;9. Extraordinary Professor, Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town
Abstract:BackgroundReduction of the posterior aspect of proximal humerus fracture, such as far-retracted greater tuberosity or posterior articular head split fracture via a deltopectoral or deltoid splitting approach, is difficult and usually needs extensive dissection. The inverted-L anterolateral deltoid flip approach, which is developed from the deltoid splitting approach, accesses the proximal humerus via lateral deltoid flap lifting. This study compared the area and arc of surgical exposure to the proximal humerus of this proposed approach to existing approaches.MethodsEleven cadaveric specimens were used. Deltopectoral and deltoid splitting approaches were carried out on the right and left shoulder, respectively. Soft tissue was retracted after completion of a surgical approach to expose the proximal humerus, and dot-to-dot marking pins were placed along the border of exposed area. An additional area with a full shoulder rotation was also marked on the deltopectoral side. An inverted-L deltoid flip approach was further carried out on a deltoid splitting side with a posterior extending incision along the acromion process and the deltoid detachment from the acromion process. The additional area of exposure was subsequently marked. All soft tissue around the proximal humerus was taken down, and the glenohumeral joint was disarticulated. Area of exposure and axial images were taken for further processing and measurement.ResultAn average distance of the axillary nerve from the acromion process of the deltoid splitting and the deltopectoral approaches were 49.15 mm and 57.35 mm, respectively (P < 0.05). The average area of exposure of the inverted-L deltoid flip, deltoid-splitting, deltopectoral, and deltopectoral with full rotation approaches were 2729.81mm2, 1404.39mm2, 1325.41mm2, and 2354.78mm2, respectively (P < 0.05). Mean arc of exposure lateral to bicipital groove of the inverted-L deltoid flip, deltoid splitting, deltopectoral, and deltopectoral with full rotation approaches were 151.75degrees, 105.02degrees, 61.68°, and 110.64°, respectively (P < 0.05).ConclusionThe inverted-L anterolateral deltoid flip approach provides the most posterior access to the proximal humerus. However, it requires more soft tissue dissection and awareness of tension on the axillary nerve. This approach could be an alternative for displaced posterior head splits or far-retracted greater tuberosity proximal humerus fractures.
Keywords:
本文献已被 ScienceDirect 等数据库收录!
设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号