加压钢板及螺钉前外侧与内侧入路修复肱骨中下段骨折:疗效及安全性评价  

Anterolateral and medial approach fixation with compression plate and screw for middle and inferior humeral fractures:efficacy and safety

作　　者：吴畏 汪海波 

机构地区：[1]重庆市红十字会医院骨科,重庆市400020

出　　处：《中国组织工程研究》2015年第31期5011-5015,共5页Chinese Journal of Tissue Engineering Research

基　　金：重庆市红十字会医院骨科对本次研究的大力支持

摘　　要：背景:目前对肱骨中下段骨折主要采用复位内固定治疗,内固定入路方式主要有3种:前外侧入路(包括改良上臂前外侧入路)、后侧入路以及内侧入路。目前临床对肱骨中下段骨折的修复入路一直存在争议。目的:对比加压钢板及螺钉前外侧入路与内侧入路内固定修复肱骨中下段骨折的疗效及安全性。方法:将重庆市红十字会医院收治的90例肱骨中下段骨折患者按随机数字表法分为两组,每组45例。对照组采用前外侧入路加压钢板及螺钉置入内固定,试验组行内侧入路加压钢板及螺钉置入内固定。比较两组患者手术时间、术中失血量、并发症以及肩关节和肘关节恢复情况。结果与结论:试验组内固定后术中失血量显著低于对照组(P<0.05),两组患者手术时间、骨折愈合时间比较差异无显著性意义(P>0.05)。随访6个月,两组患者肩关节功能Neer评分和肘关节功能Mayo评分比较差异均无显著性意义(P>0.05)。随访期间两组患者均无切口感染、骨不连、慢性骨髓炎等并发症发生。提示内侧入路与前外侧入路加压钢板及螺钉置入内固定修复肱骨中下段骨折效果相当,且前者术中失血量更少,可有效弥补传统修复方案的部分缺陷,可以考虑作为肱骨中下段骨折内固定的修复入路方式之一。BACKGROUND：Reduction and fixation are presently used for middle and inferior humeral fractures. The methods of fixation approach include anterolateral （including modified upper arm anterolateral）, posterior and medial approaches. The repair approach of middle and inferior humeral fractures remains controversial. OBJECTIVE：To compare efficiency and safety of anterolateral and medial approach fixation with compression plate and screw for middle and inferior humeral fractures. METHODS：A total of 90 cases of middle and inferior humeral fractures treated in Chongqing Red Cross Hospital were equaly and randomly divided into experimental group and control group. In the control group, patients were subjected to compression plate and screw through anterolateral approach. In the experimental group, patients were subjected to compression plate and screw through medial approach. Operation time, intraoperative blood loss, complications and the recovery of shoulder joint and elbow joint function were compared in patients of both groups. RESULTS AND CONCLUSION：Intraoperative blood loss was significantly lower in the experimental group than in the control group （P 〈 0.05）. No significant difference in operation time and fracture healing time was found between the two groups （P 〉 0.05）. During 6 months of folow-up, no significant difference in shoulder jointnbsp;function Neer score and elbow joint function Mayo score was detected between the two groups （P 〉 0.05）. During the folow-up period, no wound infection, bone nonunion or chronic osteomyelitis appeared in both groups. These data confirm that the effects of medial approach and anterolateral approach for middle and inferior humeral fractures are similar. Medial approach leads to less blood loss, can effectively make up for the defects of the traditional repair scheme, and can be considered as one of fixation approach for middle and inferior humeral fractures.

关 键 词：植入物 骨植入物 前外侧入路 内侧入路 肱骨中下段骨折 加压钢板 镙钉 内固定 Neer评分 Mayo评分 

分 类 号：R318[医药卫生—生物医学工程]