肱骨干骨折微创手术治疗策略及结果分析  

Treatment strategy and clinical effect of minimally invasive surgery for humeral shaft fractures

作　　者：陈晓斌 李学军[1] 卢猛[1] 肖犇[1] 何远铭 邱道静 CHEN Xiao-bin;LI Xue-jun;LU Meng;XIAO Ben;HE Yuan-ming;QIU Dao-jing(Department of Orthopedics,Affiliated Beijing Tongren Hospital of Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院骨科,北京100176

出　　处：《中国骨与关节损伤杂志》2023年第1期43-46,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的研究分析肱骨干不同部位骨折的微创手术治疗策略及其临床疗效。方法回顾性分析自2018-01—2020-01诊治的82例肱骨干骨折,肱骨髓内钉内固定近段骨折16例、中段骨折22例,前方入路钢板内固定中段骨折18例、远段骨折21例,闭合复位外固定架固定5例。结果82例均获得随访,随访时间平均15.1(12~25)个月。80例(97.6%)骨折愈合,骨折不愈合2例均为肱骨中段骨折髓内钉内固定,采用附加钢板联合植骨治疗后愈合;桡神经损伤2例均为前方入路钢板内固定,损伤原因为骨折断端钳夹损伤和螺钉钉尾刺激。髓内钉内固定患者术后1个月肩关节功能UCLA评分平均28.7(24~31)分,术后3个月平均31.5(26~34)分,术后6个月平均33.3(27~34)分,术后12个月平均33.5(27~35)分;术后1个月肘关节功能Mayo评分平均83.3(75~93)分,术后3个月平均90.7(89~98)分,术后6个月平均95.5(91~100)分,术后12个月平均96.3(92~100)分。前方入路钢板内固定患者术后1个月术后1个月肩关节功能UCLA评分平均29.7(28~32)分,术后3个月平均32.0(30~35)分,术后6个月平均34.1(31~35)分,术后12个月平均34.3(31~35)分;术后1个月肘关节功能Mayo评分平均82.4(73~89)分,术后3个月平均89.7(83~95)分,术后6个月平均94.2(90~100)分,术后12个月平均95.2(90~100)分。结论肱骨干骨折可根据骨折部位选择不同的微创手术治疗方式,近段骨折选择髓内钉内固定,中段骨折选择髓内钉内固定或前方入路钢板内固定,远段骨折选择前方入路钢板内固定,特殊患者可选择外固定架固定,总体疗效满意。Objective To analyze the treatment strategy and clinical effect of minimally invasive surgery for different sites of humeral shaft fractures.Methods Eighty-two cases diagnosed and treated as humeral shaft fracture from January 2018 to January 2020 were analyzed retrospectively.Sixteen proximal fractures and 22 middle fractures of humeral shaft were fixed with humeral intramedullary nail,18 middle fractures and 21 distal fractures of humeral shaft were fixed with anterior approach plate,and 5 cases were fixed with closed reduction external fixator.Results The average follow-up time was 15.1(12-25)months.Eighty fractures obtained healing(97.6%),2 cases of nonunion were fixed with intramedullary nail,healed after the treatment of additional plate combined bone grafting.Two cases of radial nerve injury were fixed with plate through anterior approach,and the causes of injury were clamp injury at the broken end of fracture and stimulation of screw tail.In the intramedullary nailing group,the mean UCLA score at 1,3,6,12 months was 28.7(24-31),31.5(26-34),33.3(27-34),33.5(27-35),and the mean MEPS score was 83.3(75-93),90.7(89-98),95.5(91-100),96.3(92-100).In anterior approach plate group,the mean UCLA score of 1,3,6,12 months was 29.7(28-32),32.0(30-35),34.1(31-35),34.3(31-35),and the mean MEPS score was 82.4(73-89),89.7(83-95),94.2(90-100),95.2(90-100).Conclusion can be selected for humeral shaft fractures according to the fracture site.Intramedullary nails are selected for proximal fractures,intramedullary nails or anterior approach plates for middle fractures,anterior approach plates for distal fractures,and external fixators for special patients.The overall results are satisfactory.

关 键 词：肱骨干骨折 髓内钉内固定 钢板内固定 外固定架固定 微创 

分 类 号：R687.3[医药卫生—骨科学]