手法复位结合微创改良入路弹性髓内钉逆行内固定治疗成人肱骨干骨折  

The Treatment of Humeral Shaft Fracture in Adults by Retrograde Internal Fixation with Elastic Intramedullary Nail via Manual Reduction and Improved Approach with Minimally Invasion

作　　者：李伟元 孙卫强 刘坤 王晓波 徐立民 杨晶 刘波 LI Weiyuan;SUN Weiqiang;LIU Kun;WANG Xiaobo;XU Limin;YANG Jing;LIU Bo(Department of Traumatology,Wendeng Osteological Hospital of Shandong Province,Weihai 264400,Shandong China.)

机构地区：[1]山东省文登整骨医院四肢创伤科,山东威海264400

出　　处：《中国中医骨伤科杂志》2021年第1期49-53,58,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨手法复位结合微创改良入路弹性髓内钉逆行内固定治疗成人肱骨干骨折的方法,并评价其疗效。方法:回顾性分析从2012年1月至2019年10月,以手法复位结合微创改良入路弹性髓内钉逆行内固定治疗62例成人肱骨干骨折患者的临床资料。其中男35例,女27例;年龄18~79岁,平均45.2岁。患者均应用手法复位结合微创改良入路弹性髓内钉经皮逆行穿针内固定治疗,术后观察患侧肩疼痛、功能、运动范围、解剖复位情况,观察患侧肘关节疼痛、运动功能、稳定性、日常活动等情况。末次随访时采用疼痛视觉模拟评分(VAS)评估患臂疼痛情况,采用Neer评分评定患侧肩关节疗效,采用Mayo评分评价患侧肘关节总体功能。结果:62例患者均顺利完成手术,手术时间12~74min,平均34min;出血量10~45mL,平均29mL。62例均获得随访10~48个月,平均19.5个月。患者术后均无神经血管损伤、骨不连、关节僵硬等情况发生。骨折均获得愈合,愈合时间为9~28周,平均20.3周。末次随访时VAS评分为0~3分,平均0.7分;Neer评分为85~100分,平均94分;Mayo评分为90~100分,平均97分。疗效评定为优58例,良4例,优良率100%。结论:手法复位结合微创改良入路弹性髓内钉经皮逆行穿针内固定治疗成人肱骨干骨折疗效满意,该方法具有微创、易于操作,出血少、固定可靠、并发症少,无需二次住院取内固定,无明显手术疤痕等优点。Objective:To explore the method of retrograde internal fixation with elastic intramedullary nail via improved approach with minimally invasion for the treatment of adult humeral shaft fracture,and to evaluate its curative effect.Methods:62adult patients of humeral shaft fracture were treated by retrograde internal fixation with elastic intramedullary nail through manual reduction and improved approach with minimally invasion from January 2012to October 2019.The clinical data were analyzed retrospectively.There were 35males and 27females,with an average age of 45.2years old(18-79 years old).The pain,function,range of motion and anatomical reduction of the affected shoulder were observed.At the same time,the pain,movement function,stability and daily activities of the affected elbow joint were observed.At the last follow-up,visual analogue scale(VAS)was used to evaluate the pain of the affected arm,Neer score was used to evaluate the effected shoulder joint,and Mayo score was used to evaluate the overall function of the elbow joint.Results:All of the 62patients completed the operation successfully,the average operation time was 34min(12-74min),and the average bleeding volume was 29mL(10-45mL).62cases were followed up for 10-48months,with an average of 19.5months.There was no neurovascular injury,nonunion and joint stiffness after operation.All fractures healed very well,the average healing time was 20.3weeks(9-28weeks).At the last follow-up,VAS score was 0-3with average of 0.7,and the Neer score was 85-100with an average of 94,and the Mayo score was 90-100with an average of 97.The excellent rate was 100%with 58cases of excellent and 4cases of good.Conclusion:The treatment of adult humeral shaft fracture by retrograde internal fixation with elastic intramedullary nail through manual reduction and improved approach with minimally invasion is satisfied.This method has the advantages of minimally invasion,easy operation,less bleeding,reliable fixation,less complications,no need for secondary hospitalization to remove t

关 键 词：肱骨干骨折 弹性髓内钉 手法复位 改良入路 逆行 

分 类 号：R683.41[医药卫生—骨科学]