摘要
目的观察肱骨尺侧结合前侧微创经皮钢板内固定(MIPPO)入路双钢板内固定治疗肱骨干下1/3骨折的临床疗效。方法回顾性分析自2012年1月至2015年5月入住本科,诊断为"肱骨干下1/3骨折"的20例患者。全部采用肱骨尺侧结合前侧MIPPO入路双钢板内固定治疗。统计手术时间,术中出血量,术后观察桡神经、尺神经、肌皮神经功能,骨折愈合时间,采用Neer肩关节功能评分及Mayo肘关节功能评分评估肩、肘关节功能。结果本组20例患者手术时间60~110 min,平均(85.0±6.5)min;出血量30~60 ml,平均(53.0±7.2)ml;术后切口均一期愈合;无医源性桡神经、尺神经、肌皮神经及重要血管损伤,无内固定失败的病例;骨折愈合时间10~15周,平均(13.0±2.1)周;肘关节最大屈曲范围131°~146°(137.60°±3.51°);肘关节最大伸直范围0°~5°(2.70°±0.91°);Mayo肘关节功能评分80~100(92.04±5.72)分;Neer肩关节功能评分85~100(93.63±4.11)分。结论尺侧入路与常用的前外侧、后侧、外侧入路相比,无需暴露桡神经,避免其带来的医源性损伤;暴露范围大(特别针对内侧蝶形骨块能达到解剖复位),手术时间短;出血少;内侧切口隐蔽、美观;同时结合前侧MIPPO呈90°双钢板固定肱骨干下1/3骨折,防止单钢板固定失效,在提供坚强的骨折稳定的同时带来更快的骨折愈合。目前随访病例无钢板失效、骨不连及血管、神经损伤。肱骨尺侧结合前侧MIPPO入路双钢板内固定治疗肱骨干下1/3骨折疗效确切,值得临床推广。
Background Humeral shaft fracture refers to the rupture between the surgical neck of 1-2 cm below and the humeral condyle of 2 cm above, which mostly occurs in the middle of the humeral shaft, followed by the lower part and the upper part. The lower third humeral shaft fracture is clinically common and associated with radial nerve injury. It is often caused by indirect violence and presented as oblique or spiral, which is prone to nonunion. Due to the high incidence of radial nerve injury and nonunion, the treatment is more intractable. Alternative methods for surgical procedure involve external fixator, intramedullary nail, plate, etc., and internal fixation and open reduction is generally considered to be the most reliable treatment method. The standard surgical approaches for open reduction and plate fixation include anterior lateral approach, anterior approach, anterior MIPPO technique approach, posterior approach, and medial approach(ulnar approach). The literature reported that the incidences of iatrogenic radial nerve injury caused by the anterolateral approach, the anterior approach, and the posterior approach were 1/5, 1/25 and 1/9, respectively. In the meanwhile, according to other articles, the incidence of nonunion of this fracture type after open reduction was as high as 15%. The causes of nonunion are attributed to traumatic factors, surgical dissection, etc., but this is mainly due to the fact that single plate fixation does not provide sufficient stability for some "special" fractures. For this purpose, this paper puts forward the specialty of ''lower third humeral shaft fracture'', emphasizing the necessity of double plates for such fractures. In the meanwhile, the ulnar approach and the anterior MIPPO approach with dual minimally invasive incisions and double plates for rigid internal fixation of lower third humeral shaft fracture were proposed in view of the high incidence of iatrogenic radial nerve injury. The active and passive elbow extension and flexion started without any b
作者
林焱斌
叶友友
王海洋
庄研
李仁斌
熊国胜
李杰辉
Lin Yanbin;Ye Youyou;Wang Haiyang;Zhuang Yan;Li Renbin;Xiong Guosheng;Li Jiehui(Department of Orthopaedics,Affiliated Fuzhou Second Hospital of Xiamen University,Fuzhou 350007,China)
出处
《中华肩肘外科电子杂志》
2018年第3期207-213,共7页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
基金
福建省中青年骨干人才培养项目(2014-ZQN-34)