肱骨干中下段骨折前外侧与后侧手术入路的比较  

Comparison between anterolateral and posterior surgical approach for treatment of mid-lower humeral fractures

作　　者：胡国东[1] 赵福龙[1] 王雪飞[1] 张学东[1] 葛双雷[1] 吕振刚[1] 窦越超[1] 张亚奎[1] 于振山[1] 

机构地区：[1]北京市通州区潞河医院骨科,101149

出　　处：《中国骨与关节损伤杂志》2013年第1期28-30,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨前外侧与后侧入路治疗肱骨干中下段骨折的疗效。方法回顾性分析自2005年1月～2009年1月采用前外侧与后侧入路治疗82例肱骨干中下段骨折的临床情况,术前明确桡神经损伤的10例采用远1/3前外侧入路,其余72例随机选择手术入路,其中前外侧入路34例,后侧入路38例。结果 82例内固定手术患者,去除术前即有桡神经症状的10例,平均随访14个月(8.5～19.3个月)。骨折愈合时间平均3.5个月,其中不愈合5例。术后出现桡神经症状18例,前外侧入路组16例,而后侧入路组2例。前外侧与后侧入路两组性别、年龄、骨折类型及愈合时间差异无统计学意义,后侧入路组较前外侧入路组在神经损伤方面小一些,且差异有统计学意义。结论后侧入路较前外侧入路能够明显减少桡神经损伤。治疗肱骨中下段骨折,后侧入路手术相对简单,安全,是一种较好的手术入路。Objective To explore the clinical efficacy of anterolateral and posterior approach for the treatment of mid-lower humeral fractures. Methods Eighty-two patients received the treatment of anterolateral and posterior approach from July 2005 to July 2009,for mid-lower humeral fractures. Their conditions of bone union and functional restoration were retrospectively analyzed. Ten patients with radial nerve injury diagnosed preoperatively received far 1/3 of the anterolateral approach, the remaining 72 patients were randomly selected surgical approach, in which anterolateral 34 cases, 38 cases of posterior approach. Results All of 82 cases received internal fixation surgery to remove the preoperative radial nerve symptoms in 10 patients. Mean follow-up was 14 months （8.5～19.3 months）. The average healing time was of fracture 3.5 months, which did not heal in 5 cases. Postoperative radial nerve symptoms occurred in 18 eases, including 16 patients in anterolateral group of, and 2 patients in posterior approach group. Patients with anterolateral and posterior approach in the two groups had no significant difference in gender, age, bone healing time and fracture type. Posterior approach group was less than in the anterolateral group of smaller areas about the nerve injury, and the difference was statistically significant. Conclusion Posterior approach is more secure than anterolateral, and has significantly less damage to the radial nerve. Treatment of humeral shaft fractures of the mid-lower section, posterior approach surgery is relatively simple, safe, and it is a better surgical approach.

关 键 词：肱骨骨折 桡神经损伤 前外侧入路 后侧入路 

分 类 号：R683.41[医药卫生—骨科学]