微创前置钢板固定技术对肱骨干中下段血供影响的解剖学研究  

Influence of minimal invasive anterior plating osteosynthesis on blood supply to the middle and distal third humeral shaft

作　　者：薛子超[1] 姜朝来[1] 秦晖[1] 胡传真[1] 安智全[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》2014年第10期881-884,共4页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81171704）.

摘　　要：目的 对比传统经后侧入路切开复位内固定技术与微创前置钢板固定（MIAPO）技术对肱骨干中下段血供的影响. 方法 采用健康成人新鲜冷冻上肢标本6对（12具）,男4对,女2对;死亡年龄54 ～ 87岁（平均68.3岁）.每对为一组（左、右各一具）,随机选择左、右侧分别行经后侧入路切开复位内固定术和MIAPO技术后,所有标本经腋动脉灌注乳胶-四氧化三铅液,行X线片检查并解剖观察,对比分析肱骨中下段主要动脉分支的走形与手术破坏情况. 结果 全部12具标本肱骨干中下段均只有1支主要滋养动脉,分别于肱骨干前内侧面[10/12（83.3％）]和内侧面[2/12（16.7％）]进入肱骨，对于肱骨干后侧的辅助滋养动脉（共17支）,MIAPO技术未予破坏（0支）,而后侧入路切开复位内固定术则有不同程度的破坏（9支,52.9％）,在骨膜充盈方面,MIAPO技术也优于后侧入路切开复位内固定术：差异明显3对,中度差异2对,轻度差异1对,结论 与传统经后侧入路切开复位内固定技术相比,采用MIAPO技术固定肱骨中下段骨折可在避免造成术中医源性桡神经损伤的同时,对肱骨中下段血供的影响较小。Objective To compare minimal invasive anterior plating osteosynthesis （MIAPO） and conventional plating osteosynthesis in terms of influence on the blood supply to the middle and distal third humeral shaft.Methods Six pairs of freshly frozen cadaveric specimens of human upper limb were used for this study.They were from 4 males and 2 females who were 54 to 87 years of age （mean,68.3 years）.Each pair had one left and one right upper limb.After MIAPO and conventional plating osteosynthesis were used randomly on the left or right side in each pair of specimens,latex-red lead was then injected through the axillary artery.X-ray and anatomic examinations were conducted to observe the paths and disruptions of main vessels in the middle and distal third humeral shaft.Results There was one main nutrient artery entering the humeral shaft at the anteromedial （83.3％） and medial （16.7％） aspects.MIAPO did not damage the accessory nutrient arteries （altogether 17） at the back of the humeral shafts （0） while the conventional posterior approach damaged them more or less at different levels （9,52.9％）.MIAPO also showed superior periosteal filling compared with the conventional posterior approach （significantly better in 3 pairs,moderately better in 2 pairs and mildly better in one pair）.Conclusions Compared with the conventional plating,MIAPO leads to less disruption to the blood supply to the middle and distal third humeral shaft while it avoids intraoperative iatrogenic injury to the radial nerve.

关 键 词：肱骨骨折 外科手术 微创性 骨折固定术 内 灌注 

分 类 号：R687.3[医药卫生—骨科学]