肱骨后侧切口、外侧肌间隔入路内固定治疗肱骨中下段骨折的临床疗效  

Clinical curative effect observation of middle-lower humeral fracture with posterior humeral incision and lateral intermuscular septum approach

作　　者：唐晓俞 罗维 江显俊 王雨 Tang Xiaoyu;Luo Wei;Jiang Xianjun;Wang Yu(Department of Trauma,Number One Orthopaedics Hospital of Chengdu,Chengdu 610031,China;Department of Oncology,The Third Affiliated Hospital of the Third Military Medical University,Chongqing 400042,China;The First Clinical College,Zhejiang Chinese Medical University,Hangzhou 310053,China;Grass City Royal River Community Health Service Center,Chengdu 610031,China)

机构地区：[1]成都第一骨科医院创伤病区,610031 [2]第三军医大学第三附属医院肿瘤科,重庆400042 [3]浙江中医药大学第一临床医学院,杭州310053 [4]草市御河社区卫生服务中心,成都610031

出　　处：《中华肩肘外科电子杂志》2018年第3期199-206,共8页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的探讨后侧切口、外侧肌间隔入路内固定治疗肱骨中下段骨折的临床疗效。方法对2013年5月至2015年5月成都第一骨科医院收治的44例采用切开复位钢板螺钉内固定术治疗的闭合性肱骨中下段骨折患者进行回顾性分析,其中25例患者采用肱骨后侧切口、外侧肌间隔入路(后侧入路组),19例患者采用前外侧入路(前外侧入路组)。44例患者均获得随访,平均随访时间12个月。两组患者围手术期处理情况相同,对比分析两组之间的手术时间、术中出血量、桡神经损伤情况、骨折愈合情况及肘关节功能恢复情况。结果后侧入路组手术时间为(65.18±3.50)min,前外侧入路组手术时间为(85.73±6.16)min,后侧入路组术中出血量为(222.95±44.55)ml,前外侧入路组为(281.34±34.82)ml,经统计学检验两组间差异具有统计学意义(P<0.05)。两组术后桡神经损伤情况、骨折愈合时间及肘关节Broberg和Morrey评分基本相当,差异无统计学意义(P>0.05)。两组患者骨折均在1年内愈合,前外侧入路组1例桡神经损伤患者在术后3个月内恢复。结论对肱骨中下段骨折采用肱骨后侧切口、外侧肌间隔入路手术治疗,可操作性强,手术时间短,术中出血量较少,手术安全性高,肱骨后侧骨骼平坦,利于放置钢板,无须特别塑形钢板,不影响肘关节功能,推荐在临床上使用后侧切口、外侧肌间隔入路的方式治疗肱骨中下段骨折。Background Humeral shaft fracture is common in clinic, and it accounts for 1%-1.5% of all fractures in whole body. The fracture is commonly located in the middle and distal parts of humerus, which is usually unstable. The conventional treatment method was internal fixation, and the strategies for treating the fracture of middle-lower humerus include anterolateral approach, posterior approach and anterior approach. The anterolateral approach was the most commonly used previously, which was also adopted by the author in early years. With the development of internal fixation device, the posterior approach was used by more and more surgeons for the treatment of middle-lower humeral fracture due to clear operation field, adequate radial nerve exposure, flat surface of posterior humeral shaft, and easy plate placement without shaping. For posterior approach, the posterior humeral shaft was exposed via triceps-splitting approach or posterior incision and lateral intermuscular septum approach. Using posterior incision and lateral intermuscular septum approach, the author found that this strategy had the advantagesof clear anatomic structure, adequate exposure and easy internal fixation. Therefore, this study retrospectively analyzed the clinical effects of posterior incision and lateral intermuscular septum approach and anterolateral approach for the treatment of middle-lower humeral fracture. Methods （1）General information. From May 2013 to May 2015, a total of 44 patients （25 males and 19 females） with middle-lower humeral fracture were treated in the Number One Orthopaedics Hospital of Chengdu. The age ranged from 24 to 58 years with an average of 36.81 years. All cases were fresh closed fracture caused by trauma, including 12 cases of fall damage, 4 cases of wrist injury, 15 cases of high fall and 13 cases of traffic accident. Among them, 19 cases had the left side affected, and 25 cases had the right side affected. Furthermore, there were 4 cases of transverse fracture, 3 cases of multiple fracture, 24 ca

关 键 词：肱骨后侧入路 外侧肌间隔 肱骨骨折 内固定 

分 类 号：R687.3[医药卫生—骨科学]