前置钢板微创固定治疗肱骨干中下段骨折的可行性研究  

Minimally invasive treatment of mid-distal third humeral shaft fractures with anterior plating

作　　者：安智全[1] 何小健[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤骨科杂志》2009年第6期520-522,共3页Chinese Journal of Orthopaedic Trauma

摘　　要：目的评价采用微创前置钢板固定技术治疗肱骨干中下段骨折对挠神经、肌皮神经和肱二头肌功能的影响。方法2004年5月至2007年12月，采用闭合复位、经上臂前侧远离骨折部位的小切口微创钢板固定技术（MIPO）置入4．5mm窄动力加压钢板治疗20例肱骨干中、下段闭合性骨折患者。观察术后桡神经功能、肌皮神经功能、前后位肱骨干力线、骨折愈合时间和最后一次随访时肱二头肌肌力。结果4例患者术后出现前臂外侧皮神经支配区麻木，无医源性桡神经麻痹患者。肱骨干前后位X线片示骨折远、近端0°成角7例，2例内翻成角达11°，内翻成角2°、3°、4°、5°、6°、7°和10°各1例。外翻成角3°,4°、6°和7°各1例。19例患者得到平均10．4个月（8～32个月）随访，骨折均获得愈合，平均骨折愈合时间13．4周（4～32周）。全部患者肱二头肌肌力均为5级。结论采用前置钢板微创固定技术治疗肱骨中、下骨折不会损伤桡神经和肱二头肌，但可能会干扰前臂外侧皮神经的功能。Objective To evaluate effects of minimal invasive plating for treatment of mid-distal humeral shaft fractures. Methods From May 2004 to December 2007, 20 patients with isolated unilateral mid-distal third humeral shaft fractures were surgically treated with close reduction and internal fixation using a 4.5 mm dynamic compression plate which was anteriorly inserted through 2 small incisions on the anterior aspects of proximal and distal parts of the arm, away from the fracture site. The postoperative function of the radial nerve and the musculocutaneous nerve, the postoperative alignment of the main fragments on the anteroposterior radiographs, the bone healing time and muscle strength of biceps muscles were measured and recorded. Results Four patients complained of numbness at the area innervated by the lateral antebrachial cutaneous nerve in the affected forearm after the surgery. No signs of iatrogenic radial nerve palsies oecurred after the surgery. A completely normal alignment was achieved in 7 patients, but varus of 11° was found in 2 cases and varus of 2°, 3°, 4°, 5°, 6°, 7° and 10° in one each. Valgus deformity was noticed in 4 cases, and valgus of 3°, 4°, 6° and 7° in one each. The mean follow-up of 10. 4 months for 19 patients revealed bony union of all the fractures. The average bone healing time was 13.4 weeks. At the latest follow-up, the biceps muscle strength of all the patients was 5 degrees. Hardwires were removed in 5 patients without any complications. Conclusions Minimally invasive anterior plating is a safe alternative osteosynthesis for mid-distal third humeral shaft fractures. However, this technique may interfere with the function of the lateral antebrachial cutaneous nerve.

关 键 词：肱骨骨折 骨折固定术 内 外科手术 微创性 

分 类 号：R686[医药卫生—骨科学]