前侧入路钢板前置治疗肱骨中下段骨折的解剖研究及临床应用  

Anatomic study and clinical application of the anterior approach plate for the treatment of fracture of the middle and lower humerus

作　　者：姜砚劼 严正[1] 占晨光 JIANG Yan-jie;YAN Zheng;ZHAN Chen-guang(Section Ⅰ,Dept of Traumatology,the Forth Hospital of Huangshi City,Huangshi,Hubei 435006,China)

机构地区：[1]黄石市第四医院创伤一科,湖北黄石435006

出　　处：《临床骨科杂志》2018年第5期578-581,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨肱骨中下段骨折在不损伤桡神经、不影响屈肘肌力情况下,钢板前置手术入路的手术方式。方法 (1)在10具成人尸体的20侧上肢标本上对肱骨前入路中的神经、血管进行测量。(2) 50例肱骨中下段骨折钢板内固定患者分别采用前外侧入路(A组,20例)和前内侧入路(B组,30例)。比较两组手术时间、术中出血量、骨折愈合时间及Mayo肘关节功能评分(MEPS)、肩关节Neer评分、屈肘肌力,评价疗效。结果手术时间及术中出血量B组少于A组(P <0. 05),骨折愈合时间两组差异无统计学意义(P> 0. 05);术后12个月,肩、肘关节功能两组比较差异均无统计学意义(P> 0. 05);并发症发生率B组低于A组(P <0. 05)。结论前内侧入路置入钢板治疗能避免损伤桡神经及尺神经,不影响屈肘肌力,且手术时间较短、术中出血量较少,并发症发生率低。Objective To investigate the surgical approach with plate preposition for middle and lower segment fractures of the humerus without damaging radial nerve injury and affecting the flexor elbow muscle strength. Methods① The relevant nerves and blood vessels of the anterior approach of humerus were measured at the 10 adult cadavers （20 upper limbs） . ② Fifty patients with humeral middle and lower segments fractures were treated with plate fixation via anterolateral approach （group A, 20 cases ） and anterior medial approach （group B, 30 cases）, respectively. These data were compared,including the operative time, intraoperative bleeding volume, fracture healing time, Mayo elbow performance score（MEPS）, shoulder Neer score, flexion and elbow muscle strength,the results were used to evaluate the curative effect. Results The operation time and intraoperative bleeding volume in the group B were less than those of group A（ P 〈0.05）, and there was no significant difference for the fracture healing time between the two groups （ P 〉0.05）.At 12 months postoperation,there was no significant difference between the two groups of the shoulder and elbow joint function（ P 〉0.05）.The incidence rate of complications in the group B was lower than that of the A group （ P 〈0.05）. Conclusions The treatment of anterior medial approach can avoid injuries of the radial nerve and ulnar nerve, and does not affect the elbow flexion, and the operation time is shorter, the intraoperative bleeding volume is less, and the incidence rate of complications is low.

关 键 词：改良肱骨前侧入路 桡神经外置 肱骨骨折 

分 类 号：R683.41[医药卫生—骨科学] R687.3[医药卫生—外科学]