用MIPO技术治疗肱骨干中下段骨折的解剖及初步临床报告  

Treatment of mid-distal humeral shaft fractures using minimally invasive plating osteosynthesis (MIPO) technique:anatomical considerations and preliminary clinical results

作　　者：安智全[1] 曾炳芳[1] 王烨明[1] 张驰[1] 黄沛彦[1] 

机构地区：[1]交通大学附属第六人民医院创伤骨科,上海200233

出　　处：《中华手外科杂志》2006年第6期336-338,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨肱骨干中下段骨折的治疗方法。方法8具成人尸体上肢标本,经上臂近段前侧肱二头肌和三角肌间隙以及远端肘横纹近侧肱二头肌外侧缘的皮肤小切口,插入窄4．5 mm动力加压钢板置于肱骨干前侧,肱肌深面,两端分别用2枚螺钉固定,测定前臂旋后位桡神经在穿出外侧肌间隔以及冠状窝上缘水平与钢板外侧缘的距离。采用闭合复位、经皮前置钢板内固定技术治疗16例肱骨干中下段骨折。记录手术时间、术中失血量、术后平均住院时间、术后近期并发症、骨折愈合时间及肩、肘关节活动范围。结果经上臂小切口将钢板固定于肱骨干前侧后,钢板的近端位于肱二头肌长头腱和肌皮神经外侧。钢板大部分位于肱肌深面。前臂旋后位,桡神经在穿经外侧肌间隔和冠状窝上缘水平与钢板外侧缘之间的距离平均分别为16．5 mm(10．3～21．3 mm)和5．4 mm(3．7～7．7 mm)。钢板与桡神经之间间隔有肱肌肌腹。16例患者平均手术时间为120 min(90～150 min),术中失血量为50～200 ml,术后平均住院时间为4 d(3～5 d)。没有发生医源性桡神经麻痹的病例。无切口感染。术后随访7～24个月,骨折全部愈合,平均愈合时间为15．4周(12～32周)。肘关节屈曲135°～145°,伸直0°～5°,肩关节外展90°,上举150°～170°。结论采用MIPO技术治疗肱骨干中下段骨折可获得良好的结果。Objective To explore the pessibility and clinical effects of the treatment of mid-distal humeral shaft fractures using minimally invasive plating osteosynthesis （MIPO） techniques. Methods 8 fresh-frozen cadaveric upper extremity specimens were used for anatomic study. A small incision was made on the anterior side of the arm between the deltoid muscle and biceps muscle. An additional small incision was made along the lateral side of the biceps muscle proximal to the elbow flexion crease. A straight narrow 4.5 mm dynamic compression plate was inserted through the incisions under the brachial muscle and positioned on the anterior side of the humeral shaft along the axial line. The distal end of the plate was located at the distal humerus proximal to the coronoid fossa. The plate was then fixed to the humeral shaft with two screws at each end of the plate through the incisions. Following plate fixation, the radial nerve and the plate were exposed in situ. The distances between the radial nerve at the point the nerve pierces the lateral intermuscular septum and at the point above the coronoid fossa were measured. 16 patients with mid-distal humeral shaft fractures were treated by closed reduction and internal fixation with the technique described above. The operation time, intraoperative blood less volume, mean hospital stay, early postoperative complications, bone healing time and range of motion of the shoulder and elbow were recorded. Results When the plate was fixated to the anterior side of humeral shaft, the proximal end of the plate was located lateral to the biceps long head and the musculocutaneous nerve. Most part of the plate was covered with brachial muscle which separated the plate from the radial nerve. When forearm was in supination, the distances between the lateral edge of the plate and the radial nerve at the point the nerve pierces the lateral intermnscular septum and at the level of the superior edge of the coronoid fossa were 16.5 mm （range 10.3-21.3 mm） and 5.4 mm （range 3.7-7.7 mm）

关 键 词：骨折 肱骨干 钢板骨固定 微创技术 

分 类 号：R687.3[医药卫生—骨科学]