PDF(Pubmed)
Abstract：
In conservative treatment for proximal humerus fractures (PHFs), the immobilization position of the affected arm should not be determined uniformly. The aim of this study is to investigate the optimal immobilization position for conservative treatment of different types of PHFs. We hypothesized that the optimal position minimizing the deforming force in PHFs depends on the fracture components involved. PHF models involving either the surgical neck (SN) or greater tuberosity (GT) were created using 12 fresh-frozen cadaveric shoulders. In the SN model, the deforming forces on the pectoralis major muscle were measured in full adduction by increasing external rotation. In the GT model, the deforming force of the supraspinatus muscle was measured in neutral rotation by decreasing abduction, and the deforming force of the infraspinatus muscle was measured in full adduction by increasing internal rotation, respectively. In the SN model, the deforming force of the pectoralis major muscle increased significantly with external rotation from full internal rotation to neutral rotation (P = 0.006), indicating that the arm should be placed in full internal rotation. In the GT model, the deforming force of the supraspinatus muscle increased significantly with adduction from 45° of abduction to full adduction (P = 0.006); the deforming force of the infraspinatus muscle increased significantly with internal rotation from neutral rotation to full internal rotation (P = 0.006). These findings should be considered when placing the arm in abduction and neutral rotation so as to minimize the deforming force by either the supra or infraspinatus muscle. In conservative treatment for PHFs, the affected arm should be placed in a position that minimizes the deforming force on the fracture components involved.
摘要：
在肱骨近端骨折（PHFs）的保守治疗中，受影响手臂的固定位置不应统一确定。这项研究的目的是探讨保守治疗不同类型PHF的最佳固定位置。我们假设使PHF中的变形力最小化的最佳位置取决于所涉及的裂缝成分。使用12个新鲜冷冻的尸体肩部创建涉及手术颈部（SN）或更大结节（GT）的PHF模型。在SN模型中，通过增加外部旋转在完全内收测量胸大肌上的变形力。在GT模型中，冈上肌的变形力是通过减少外展在中性旋转中测量的，并通过增加内旋在完全内收测量冈下肌的变形力，分别。在SN模型中，胸大肌的变形力随着从全内旋转到中性旋转的外部旋转而显着增加（P=0.006），表明手臂应完全内部旋转。在GT模型中，冈上肌的变形力随着外展45°到全内收而显着增加（P=0.006）；冈下肌的变形力随着内旋从中性旋转到全内旋而显着增加（P=0.006）。在将手臂置于外展和中性旋转时，应考虑这些发现，以最大程度地减少上肌或冈下肌的变形力。在PHFs的保守治疗中，受影响的手臂应放置在一个位置，以最大程度地减少骨折部件上的变形力。
