经皮微创钢板内固定治疗肱骨近端骨折的解剖学研究及初步临床报告  

Percutaneous locking plate osteosynthesis for fracture of surgical neck of humerus： an anatomical and clinical report

作　　者：黄沛彦[1] 董有海[1] 顾军[1] 程根祥[1] 

机构地区：[1]复旦大学附属上海市第五人民医院骨科,200240

出　　处：《中华创伤骨科杂志》2011年第8期710-714,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨经皮微创钢板内固定技术（MIPO）治疗肱骨近端骨折的可行性和临床效果。方法取8具成人尸体上肢标本，经肩峰下2cm做-4cm左右横形切口，沿肌纤维走向分层分离肌肉，并经皮沿肌下隧道贴于骨面顺行插入锁定解剖钢板，两端分别用数枚螺钉固定，测定腋神经与肩关节骨性标志间、钢板外侧缘的距离。临床上自2009年3月至2010年9月采用闭合复位、经皮锁定钢板内固定治疗18例肱骨近端骨折患者，男6例，女12例；年龄47～86岁，平均67．4岁。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。结果腋神经于肱骨后外侧横过肱骨处至肩峰、肱骨头及肱骨解剖颈下缘的垂直距离平均分别为（69．09±6．07）、（55．54±4．64）及（16．23±2．91）mm。18例患者平均手术时间为（106±36）min，术中失血量为（82±38）mL，术后平均住院时间为（6±2）d。患者术后获8～16个月（平均12．6个月）随访。本组患者术后肩关节功能优9例，良7例，可2例，优良率为88．9％。所有患者伤口均一期愈合，无一例发生医源性腋神经损伤。全部患者骨折均获愈合，平均愈合时间为16．3周（14～36周）。结论采用MIPO技术治疗肱骨近端骨折，其并发症少，临床效果良好。Objective To explore the feasibility and clinical effects of minimally invasive percutaneous plate osteosynthesis （MIPO） for humeral surgical neck fractures. Methods In 8 cadaveric specimens of adult upper limbs, a 4 cm transverse incision was made about 2 cm subacromially along the muscle fibers to dissect the muscle layers. A percutaneous locking plate was inserted along the submuscular tunnel and close to the bone surface before it was fixated at both ends with screws. The distances between the axillary nerve and the bony signs of the shoulder, as well as the distances between the axillary nerve and the lateral edges of the plate, were measured. From March 2009 to September 2010, the percutaneous locking plate was used to treat 18 cases of humeral surgical neck fractures after closed reduction. They were 6 men and 12 women, aged from 47 to 86 years （average, 67.4 years）. Operation time, blood loss, postoperative hospital stay, postoperative complications, fracture healing time, and ranges of motion of the shoulder and the elbow were documented. Results The distances between the axillary nerve and the aeromion, the humeral head and the lower edge of the humeral anatomical neck were respectively 69.09 ±6.07, 55.54 ±4.64 and 16.23 ±2.91 mm. The 18 patients were followed up for 8 to 16 months （average, 12.6 months）. On average, the operative time was 106 ± 36 min, intraoperative blood loss 82 ± 38 mL, and postoperative hospital stay 6 ± 2 days. All fractures healed without wound infection. The average healing time was 16.3 weeks （from 14 to 36 weeks） . No iatrogenic injury to the axillary nerve occurred. Conclusion MIPO is a fine treatment for humeral surgical neck fractures.

关 键 词：肱骨骨折 骨折固定术 内 解剖 

分 类 号：R687.3[医药卫生—骨科学]