微创锁定接骨板治疗非手术治疗失败的肱骨干骨折肥大型骨不连  

Application of Minimally Invasive Locking Compression Plate in Treatment of Hypertrophic Nonunion of Humeral shaft Fracture for Conservative Treatment Failure

作　　者：黄勇[1] 向明[2] 胡晓川[2] 陈杭[2] 唐浩琛[2] 杨国勇[2] 

机构地区：[1]成都中医药大学附属医院骨科,四川成都610041 [2]四川省骨科医院上肢科,四川成都610041

出　　处：《四川医学》2015年第6期838-841,共4页Sichuan Medical Journal

摘　　要：目的：探讨应用微创锁定接骨板（ MIPO）技术治疗非手术治疗失败的肱骨干骨折肥大型骨不连的临床疗效。方法2008年11月至2012年10月运用微创锁定接骨板（ MIPO）技术治疗非手术治疗失败的肱骨干骨折肥大型骨不连17例，观察手术时间、输血量、愈合情况、并发症以及功能恢复情况等。结果术中出血平均为180mL（120～300mL），手术时间60min（40～95min）；术中未输血；术后患者切口均Ⅰ期愈合，无感染等并发症发生。本组17例，其中14例（82．3%）获得随访，随访时间8～22个月，平均14．6个月。 X线片示骨折均骨性愈合，其中1例有螺丝钉松动迹象但骨折最终愈合，愈合时间3．5～8个月，平均4．9个月。4例有5°～15°的肘内翻。根据 Constant-Murley肩关节评分及Broberg-Morrey肘关节评分，肩、肘关节功能恢复均满意，其中 Constant-Murley评分术前81．6（67～94）分，术后92．2（80～100）分，肩关节功能：前屈上举162°（100°～180°）；体侧外旋平均52°（35°～90°），内旋T7-T8（T12-T5）；Broberg-Morrey评分术前80．6（62～90）分，术后94．5（73～100）分，屈曲132°（110°～140°），伸直16°（0°～35°），前臂旋转正常。结论微创锁定接骨板（ MIPO）技术是治疗非手术治疗失败的肱骨干骨折肥大型骨不连的较好方法，其固定稳定，能最大程度地减少了对骨折端血供的破坏，符合生物学固定原则，但对病例的选择需要慎重。Objective To evaluate the clinical efficiecy of minimally invasive plate osteosynthesis（ MIPO） with locking compression plate（LCP） in the treatment of hypertrophic nonunion of humeral shaft fracture for conservative treatment failure. Methods Treated 17 patients with hypertrophic nonunion of humeral shaft fracture for conservative treatment failure with MIPO technique from November 2008 to October 2012. The operation time,amount of blood transfusion,time to union,complications,and functional recovery were recorded and study Results The average amount of bleeding was 180ml（range,120-300ml）;The average duration of the surgery was 60 minutes（ range,40-95 minutes） with no blood transfusion. All surgical wound healed primarily,and there was no wound infection. 14 of 17 patients were followed up for 8-22 months with an average of 14. 6 months,Radiological ex-amination revealed all fractures healed within 3. 5-8 months with an average of 4. 9 months,although the screws loosened,the frac-ture of one patient eventually healed . All patients recovered normal carry angle except for 4 patients with 5-15° varus deviation. According to the shoulder score of Constant-Murley and the elbow score of Broberg and Morrey. The shouders and elbows of all pa-tients had satisfactory recovery eventually, The Constant-Murley Score was improved from the preoperative 81. 6 to postoperative 92. 2 . The mean forward flexion of the shoulder was 162°（range,100°to 180°）,external rotation 52°（range,35°-90°）,internal rotation at T7-T8 level（range,T12-T5）The Broberg and Morrey Score was improved from the preoperative 80. 6 to postoperative 94. 5 . The mean flexion of the elbow was 132°（range,110°to 140°）,extension 16°（0°-35°）,function of the forearm was normal. Conclusion It is the effective method for managing the hypertrophic nonunion of humeral shaft fracture for conservative treatment failure with with Minamally invasive Plate Osteosynthesis（MIPO）technique,It provides stable fixation and least

关 键 词：微创锁定接骨板 肥大型骨不连 肱骨骨折 

分 类 号：R687.3[医药卫生—骨科学]