微创技术植入锁定加压钢板治疗肱骨干近端骨折  

APPLICATION OF MINIMALLY INVASIVE LOCKING COMPRESSION PLATE IN TREATMENT OF PROXIMAL HUMERAL FRACTURES

作　　者：刘德荣 梁加利[2] 陆耀刚 

机构地区：[1]香港玛丽医院矫形及创伤外科 [2]香港大学医学院矫形及创伤外科学系 [3]上海南汇区周浦医院骨科

出　　处：《中国修复重建外科杂志》2009年第11期1282-1284,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结采用微创接骨板固定(minimally invasive plate osteosynthesis,MIPO)技术植入锁定加压钢板(locking compression plate,LCP)治疗肱骨干近端骨折的临床效果。方法2004年7月-2008年4月,采用MIPO技术植入LCP治疗26例肱骨干近端1/3移位骨折患者。其中男8例,女18例;年龄34～82岁,平均66岁。骨折按AO分型,A1型4例,A2型2例,B1型8例,B2型4例,B3型2例,C1型4例,C2型2例。合并骨质疏松8例。受伤至手术时间1～5d,平均2d。结果术后患者切口均Ⅰ期愈合,无感染等并发症发生。3例术后合并桡神经功能性麻痹,分别于术后4、6、8个月自行恢复。26例均获随访,随访时间6～24个月,平均14.1个月。X线片示25例于术后6个月内骨折达骨性愈合;1例因内固定松动发生延迟愈合,但无临床症状,于术后8个月骨折愈合,功能恢复至可。术后3个月3例发生肩关节撞击征,取出内固定行功能锻炼后功能恢复至可。采用Constant-Murley评分方法评定疗效,优11例,良10例,可5例,优良率80.8%。结论采用MIPO技术植入LCP治疗肱骨近端骨折是一种合理可行的方法,有利于肩关节早期功能恢复,术中应重视骨折复位和避免并发症的发生。Objective To evaluate the clinical and radiological outcomes of minimally invasive plate osteosynthesis （MIPO） with locking compression plate （LCP） in the treatment of proximal humeral shaft fracture. Methods From July 2004 to April 2008, 26 patients with displaced fractures of the proximal humeral shaft were recruited, including 8 males and 18 females. Age of patients averaged 66 years old （range, 34-82 years old）. According to AO classification, there were 4 cases of type A1, 2 cases of type A2, 8 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1 and 2 cases of type C2. The time from injury to surgery averaged 2 days （range, 1-5 days）. There were 8 osteoporotic fractures. Results All surgical wound healed primarily, and there was no wound infection. Three patients had postoperative radial nerve neurapraxia, which recovered at 4, 6, 8 months respectively. All patients were followed up for 6-24 months with an average of 14.1 months. Radiological examination revealed bony union within 6 months in 25 cases. There was 1 delayed union which remained asyrnptomatic and eventually healed at 8 months with acceptable Constant-Murley score. There were 3 cases of shoulder impingement syndrome diagnosed at 3 months post-operatively. After implant removal, they all achieved an acceptable Constant-Murley score. According to Constant-Murley scoring system, there were 11 excellent, 10 good and 5 acceptable results. The excellent or good rate was 80.8%. Conclusion MIPO technique using LCP is an effective method to treat proximal humeral shaft fractures, which facilitates functional recovery of the shoulder joint. During the surgery, it is important to achieve a good fracture reduction and to avoid complications.

关 键 词：微创接骨板固定技术 锁定加压钢板 肱骨干近端骨折 内固定 

分 类 号：R687.3[医药卫生—骨科学]