前侧入路微创钢板接骨术治疗成人肱骨干中下段骨折的疗效分析  

Clinical efficacy of anterior minimally invasive plate osteosynthesis in the surgical treatment of adult mid-distal humeral diaphyseal fractures

作　　者：汪李军 钱鸣雷 吴健[1] 范胜利 唐天驷[2] Wang Lijun;Qian Minglei;Wu Jian;Fan Shengli;Tang Tiansi(Department of Orthopedics,Affiliated Changshu Hospital of Nantong University,Changshu 215500,China;Department of Orthopedics,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]南通大学附属常熟医院骨科,常熟215500 [2]苏州大学附属第一医院骨科,苏州215006

出　　处：《中华解剖与临床杂志》2024年第3期179-186,共8页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨上臂前侧入路微创钢板接骨术(MIPO)治疗成人肱骨干中下段骨折的临床疗效。方法回顾性队列研究。纳入2016年10月—2022年9月南通大学附属常熟医院骨科73例成人肱骨干中下段骨折患者的临床资料, 其中男42例、女31例, 年龄18~86(53.0±20.4)岁。按照患者手术方式分组:MIPO组39例, 采用前侧入路MIPO;切开复位内固定术(ORIF)组34例, 采用前外侧入路ORIF。观察指标:比较2组患者的性别、年龄、致伤原因、外伤至手术时间、骨折AO分型等基线资料;比较2组患者手术时间、手术切口长度、术中X线透视次数、术中出血量、术后住院时间、骨折愈合时间, 记录手术并发症, 采用美国肩肘外科协会评分系统(ASES)分别于术后1周、1个月、3个月、12个月评估患侧上肢肩肘功能。结果 2组患者的性别、年龄、致伤原因、外伤至手术时间、骨折AO分型等基线资料比较, 差异均无统计学意义(P值均>0.05)。2组患者均顺利完成手术, 术后随访13~48(29.6±2.3)个月。2组患者的手术时间、术中X线透视次数、骨折愈合时间差异均无统计学意义(P值均>0.05)。MIPO组手术切口长度为(8.4±1.1)cm, 短于ORIF组的(13.8±1.9)cm;术中出血量138.0(132.0, 167.0)mL, 少于ORIF组的248.5(240.8, 290.3)mL;术后住院时间4.0(3.0, 4.0)d, 短于ORIF组的6.0(5.0, 7.0)d:差异均有统计学意义(t=-14.37, Z=-7.33、-6.29, P值均<0.001)。与ORIF组相比, MIPO组术后1周、1个月、3个月的ASES评分更高, 差异均有统计学意义(t=6.50、4.62、4.67, P值均<0.05);2组患者术后12个月ASES评分差异无统计学意义(P>0.05)。MIPO组3例术后出现患肘前侧麻木症状, 均在术后6周余恢复正常感觉;无切口感染及骨不愈合。ORIF组4例骨折延迟愈合、1例骨折感染性骨不连继发内固定断裂, 均予二次手术自体髂骨植骨术后骨折愈合;7例主诉术后患侧手部虎口区麻木症状, 观察3月余症状均完全消失Objective This study aimed to explore the clinical outcomes of anterior minimally invasive plate osteosynthesis(MIPO)in the surgical treatment of adult mid-distal humeral diaphyseal fractures.Methods A retrospective cohort study was conducted to analyze 73 patients with adult mid-distal humeral diaphyseal fractures admitted to the Affiliated Changshu Hospital of Nantong University from October 2016 to September 2022.The patients consisted of 42 males and 31 females,aged 18-86(53.0±20.4)years.They were divided into the MIPO group(n=39)and the anterolateral approach open reduction and internal fixation(ORIF)group(n=34)in accordance with the surgical procedure used.Baseline data,such as gender,age,cause of injury,duration of disease,and fracture AO classification,were compared between the MIPO and ORIF groups.Operative time,scar length,radiation exposure time,intraoperative blood loss,postoperative hospitalization time,bone healing time,and surgical-related complications were recorded and analyzed.The functional status of the shoulder and elbow was evaluated using the American Shoulder and Elbow Surgery(ASES)scoring system at different time points(1 week,1 month,3 months,and 1 year after the operation)between the MIPO and ORIF groups.Results All the operations in both groups were successfully performed,and the patients were followed up for 13-48(29.6±2.3)months.No significant difference was observed in the basic data,such as age,gender,cause of injury,duration of disease,and fracture AO classification between the MIPO and ORIF groups(all P values>0.05).No significant difference was noted in surgical time,radiation exposure time,and bone healing time between the two groups(all P values>0.05).Compared with that in the ORIF group,incision length in the MIPO group was shorter([8.4±1.1]cm versus[13.8±1.9]cm),intraoperative blood loss was less(138.0[132.0,167.0]mL versus 248.5[240.8,290.3]mL),postoperative hospital stay was shorter(4.0[3.0,4.0]days versus 6.0[5.0,7.0]days),and the differences were statistically signif

关 键 词：肱骨骨折 骨折固定术 内 外科手术 微创性 手术入路 微创钢板接骨术 成人 

分 类 号：R687.3[医药卫生—骨科学]