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Title: [Application of "door-shaft method" in limited open reduction and internal fixation with locking plate for two- and three-part fractures of the proximal humerus].
Author: Wang X, Tang X, Feng J, Zou Y, Zheng X.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Jul 15; 35(7):818-822. PubMed ID: 34308587.
Abstract:
OBJECTIVE: To investigate the effectiveness of limited open reduction via "door-shaft method" and internal fixation with locking plate for two- and three-part fractures of the proximal humerus. METHODS: The clinical data of 64 patients with proximal humeral fractures who were admitted between January 2013 and December 2016 and met the selection criteria were retrospectively analyzed. There were 23 males and 41 females, with an average age of 68.0 years (range, 50-89 years). The injuries were caused by falling in 57 cases, traffic accident in 5 cases, and falling from height in 2 cases. The interval between injury and operation was 1-7 days (mean, 2.1 days). According to Neer classification, there were 28 cases of two-part fractures and 36 cases of three-part fractures. According to the angulation direction of the proximal humeral neck shaft angle, there were 21 cases of adduction fractures and 43 cases of abduction fractures. The fractures were treated with limited open reduction via "door-shaft method" and proximal humerus internal locking systems for internal fixation. The operation time, intraoperative blood loss, number of fluoroscopy, hospital stay, and complications were recorded. The fracture healing was reviewed by X-ray film and the healing time was recorded. The shoulder joint function was evaluated by Neer score standard. RESULTS: The operation time was 45-127 minutes, with an average of 82.3 minutes. The intraoperative blood loss was 30-125 mL, with an average of 62.7 mL. Intraoperative fluoroscopy was performed 30-69 times, with an average of 37.0 times. The hospital stay was 6-23 days, with an average of 10.3 days. All incisions healed by first intention. All patients were followed up 12-37 months, with an average of 18.3 months. X-ray film re-examination showed that all fractures healed, the healing time was 12-21 weeks, with an average of 14.3 weeks. After operation, 3 cases had shoulder stiffness and 1 case had fracture malunion. At last follow-up, the Neer score of shoulder joint function was 49-97, with an average of 83.1. Among them, 38 cases were excellent, 13 cases were good, 10 cases were fair, and 3 cases were poor. The excellent and good rate was 79.7%. The excellent and good rate of patients with two-part fractures was 82.1% (23/28), and the excellent and good rate of patients with three-part fractures was 77.8% (28/36). CONCLUSION: The "door-shaft method" not only reduces the difficulty of the Joystick technique in the reduction of proximal humerus fractures, but also provides auxiliary stability. It is used for limited open reduction and internal fixation with locking plate to treat the two- and three-part fractures of the proximal humerus, which can achieve good effectiveness. 目的: 探讨“门轴法”有限切开复位锁定钢板内固定治疗肱骨近端二、三部分骨折疗效。. 方法: 回顾分析 2013 年 1 月—2016 年 12 月收治且符合选择标准的 64 例肱骨近端骨折患者临床资料。男 23 例，女 41 例；年龄 50～89 岁，平均 68.0 岁。致伤原因：摔伤 57 例，交通事故伤 5 例，高处坠落伤 2 例。受伤至手术时间 1～7 d，平均 2.1 d。骨折根据 Neer 分型为二部分骨折 28 例、三部分骨折 36 例；根据肱骨近端颈干角成角方向分型，内收型骨折 21 例、外展型骨折 43 例。术中均采用“门轴法”有限切开复位骨折后，以肱骨近端锁定内固定系统固定。记录手术时间、术中出血量及透视次数、住院时间以及并发症发生情况，X 线片复查骨折愈合情况并记录愈合时间，采用 Neer 评分标准评价肩关节功能。. 结果: 手术时间 45～127 min，平均 82.3 min；术中出血量 30～125 mL，平均 62.7 mL；术中透视 30～69 次，平均 37.0 次；住院时间 6～23 d，平均 10.3 d。术后切口均Ⅰ期愈合。患者均获随访，随访时间 12～37 个月，平均 18.3 个月。X 线片复查示骨折均愈合，愈合时间 12～21 周，平均 14.3 周。术后出现 3 例肩关节僵硬、1 例骨折畸形愈合。末次随访时，肩关节功能 Neer 评分为 49～97 分，平均 83.1 分；获优 38 例、良 13 例、一般 10 例、差 3 例，优良率为 79.7%。其中，二部分骨折患者 Neer 评分优良率为 82.1%（23/28），三部分骨折患者为 77.8%（28/36）。. 结论: “门轴法”降低了 Joystick 摇杆技术复位肱骨近端骨折的难度，也提供了辅助稳定，用于有限切开复位锁定钢板内固定治疗肱骨近端二、三部分骨折，可取得良好疗效。.

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