锁定加压接骨板微创固定治疗肱骨二或三部分骨折的初步报告  

Minimally invasive treatment of humeral multi-fractures with a locking compression plate

作　　者：杨铁毅[1] 张岩[1] 刘树义[1] 郑士伟[1] 王思辉[1] 王治[1] 吴亮[1] 黄国华[1] 姜锐[1] 刘粤[1] 

机构地区：[1]上海市浦东新区公利医院骨科,200135

出　　处：《中华创伤骨科杂志》2010年第5期442-446,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨肱骨前方入路结合锁定加压接骨板微创治疗肱骨二或三部分骨折的疗效. 方法 2005年3月至2008年10月,经肱骨前方入路应用锁定加压钢板（LCP）或肱骨近端内固定系统（PHILOS）钢板微创治疗22例肱骨二或三部分骨折患者,男13例,女9例;年龄46～78岁,平均63.4岁）;左侧7例,右侧14例.骨折类型：肱骨干骨折伴肱骨近端骨折11例,肱骨干骨折伴肱骨远端骨折8例,肱骨干骨折伴肱骨近端骨折及肩关节脱位2例,肱骨干骨折合并肱骨近端、远端骨折及肩关节脱位1例.其中2例术前伴桡神经损伤,急诊行桡神经探查后再复位固定骨折.记录手术时间及术中出血量.采用Neer肩关节评分标准及肘关节HSS评分标准分别对患者患侧肩关节和肘关节进行评分.结果 评价以1年为标准,其中1例患者术后随访不到1年,以随访终末时间为结点. 结果 22例患者的手术时间78～150 min,平均107.9 min;术中出血量110～450 mL,平均274 mL.20例术后获平均9.4个月（8～22个月）随访,2例失访.20例患者骨折均获愈合,愈合时间8～16周（平均11.5周）.骨折端无移位,螺钉无松动、拔出及断钉发生.2例术前伴桡神经损伤患者,1例3 d后功能恢复,另1例4个月后功能恢复.肩关节功能按Neer评分标准评定：优12例,良5例,中3例,优良率为85.0%.肘关节功能按HSS评分标准评定：优16例,良4例,优良率100%. 结论 肱骨前方切口经皮置入锁定加压接骨板具有创伤小、不损伤腋神经及桡神经等优点,治疗肱骨二或三部分骨折可获得较理想的临床疗效.Objective To investigate the efficacy of minimally invasive treatment of humeral multi-fractures with a locking compression plate through the anterior humeral approach. Methods From March 2005 to October 2008, 22 cases of unstable humeral multi-fractures were treated by the above method.Of them, 12 were injured in a traffic accident and 10 in daily life. There were 13 males and 9 females, with a mean age of 63.4 （ranging from 46 to 78） years. The left side was involved in 7cases, and the right side was involved in 14 cases. According to X-rays, 11 were fractures of humeral shaft and proximal humerus, 8 were fractures of humeral shaft and distal humerus, 2 were fractures of humeral shaft and proximal humerus and shoulder dislocation, and one case was fractures of humeral shaft, proximal and distal humerus and shoulder dislocation. Of them, 2 had emergency treatment of the injured radial nerve and internal fixation with Philos plate. Results The mean operative time was 107.9 min（range, 78 ～ 150 min ）, and operative blood loss was 274 mL （range, 110 ～ 450 mL）. In this group, 20 patients were followed up for 8 to 22 （average, 9. 4）months. All these patients had bone healing in 8 to 16 （average, 11.5） weeks. By Neer evaluation system,12 cases were rated as excellent, 5 as good, and 3 as fine, with the excellent-to-good rate being 85.0%. The function of elbow was rated by HSS as excellent in 16 cases and good in 4, with the excellent-to-good rate being 100%. Conclusion Minimally invasive treatment with a locking compression plate through anterior humeral approach is an effective and safe method for treating the humeral multi-fractures.

关 键 词：肱骨骨折 骨折固定术 内 外科手术 微创性 内固定器 

分 类 号：R686[医药卫生—骨科学]