肱骨干中段骨折前外侧和后侧手术入路的临床效果比较  

A clinical comparison between anterolateral and posterior approaches for the treatment of humeral mid-shaft fractures

作　　者：李一汉[1] 周君琳[1] 冷昆鹏 郭蒙 范伯元 Li Yihan;Zhou Junlin;Leng Kunpeng;Guo Meng;Fan Boyuan(Orthopedic Department of Beijing Chaoyang Hospital,Capital Medical University,Beijing 100027,China;Orthopedic Department of Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,100027 [2]首都医科大学附属北京潞河医院骨科,101100

出　　处：《中华肩肘外科电子杂志》2021年第3期249-256,共8页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：北京市自然科学基金(7202049)。

摘　　要：目的采用双中心回顾性研究分析并比较前外侧与后侧手术入路在治疗肱骨干中段骨折的临床效果和并发症。方法本研究纳入了2015年1月至2019年7月期间在首都医科大学附属北京朝阳医院骨科和首都医科大学附属北京潞河医院骨科两家医院诊断为肱骨干中段骨折并接受手术治疗的177例患者。在随访期间,每例患者均拍摄了X线片以进行评估。在术后第12个月随访时,我们用Constant评分系统、关节活动度和Mayo肘关节功能评分系统对每例患者的受累肢体进行了临床评估。结果86例A型(Ⅱ组,n=51)和B型或C型(Ⅳ组,n=35)肱骨中段骨折患者接受了前外侧手术入路治疗。91例A型(Ⅰ组,n=45)和B或C型(Ⅲ组,n=46)肱骨中段骨折患者接受了后侧手术入路治疗。Ⅰ组和Ⅱ组之间以及Ⅲ组和Ⅳ组之间,在患者人口统计学资料、手术数据、Constant评分、关节活动度和Mayo肘关节功能评分方面无明显差异。而Ⅰ组和Ⅱ组之间的总并发症发生率差异有统计学意义(P=0.011)。结论在治疗简单肱骨干中段骨折时,前外侧手术入路显著优于后侧手术入路。然而,前外侧手术入路和后侧手术入路在治疗肱骨中段粉碎性骨折中,疗效无明显差异。Background Humeral shaft fractures are prevalent for trauma patients.Surgeons usually utilize open reduction and internal fixation(ORIF)with plates and screws to treat humeral mid-shaft fractures.Humeral mid-shaft fractures are typically treated through posterior or anterolateral approaches.It is reported that ORIF via posterior approach is associated with as high as 11.5%of subsequent iatrogenic radial nerve palsy.In contrast,the anterolateral approach has a relatively lower incidence of iatrogenic radial nerve injury.However,few studies have compared the functional outcomes and complications of the posterior and anterolateral surgical approaches as far as we know.Objective To compare the functional results and complication rates between anterolateral and posterior approaches in treating humeral midshaft fractures.Methods This study included 177 patients diagnosed with humeral mid-shaft fractures and surgically treated through anterolateral or posterior approaches from January 2015 and July 2019.We collected the demographic and operation data for each patient.During follow-up visits,radiographs were acquired and evaluated.At the 12-month follow-up,the functional results of the affected elbow and shoulder were evaluated with Mayo Elbow Performance Score(MEPS),Constant score,and range of motions(ROMs).Results The anterolateral approach was performed in 86 patients with type A fractures(groupⅡ,n=51)and type B or C fractures(groupⅣ,n=35).The posterior approach was performed in 91 patients with type A fractures(groupⅠ,n=45)and type B or C fractures(groupⅢ,n=46).No significant differences were found between groupⅠand groupⅡor between groupⅢand groupⅣin demographics,operation data,fracture union time,ROMs of the shoulder and elbow joint,Constant score,or MEPS.There was a significant difference in the overall complication rate between groupsⅠand groupⅡ(P=0.011).Conclusion The anterolateral approach showed an advantage over the posterior approach to treat simple humeral mid-shaft fractures.However,thi

关 键 词：肱骨干 骨折 前外侧入路 并发症 

分 类 号：R687.3[医药卫生—骨科学]