摘要
目的探讨前外侧入路微创接骨板接骨术(MIP0)治疗肱骨中下段骨折的临床疗效。方法采用回顾性病例系列研究分析2015年8月至2018年3月中国人民解放军总医院第七医学中心收治的21例肱骨中下段骨折患者临床资料,其中男12例,女9例;年龄18〜68岁[(31.3±3.6)岁]。均为闭合性骨折。按A0分型:A型6例,B型10例,C型5例。均采用前外侧入路微创放置接骨板固定。记录手术时间、术中出血量、住院时间、手术并症,观察骨折愈合情况。术前及术后2周、3个月、12个月分别采用视觉模拟评分(VAS)、美国加州大学(UCLA)肩关节功能评分、Mayo肘关节功能评分(MEPS)进行评价结果患者均获随访12〜26个月[(18.2±2.4)个月]。手术时间为50〜82 min[(68.2±19.4)min],术中出血量为40〜95 ml[(60.2±21.3)ml],住院时间为6〜16 d[(6.8±1.2)d]。术中未发生医源性血管或神经损伤,术前合并桡神经损伤者,均为外膜挫伤,术后3个月内神经功能均恢复正常、骨折均获骨性愈合,愈合时间为5〜10个月[(5.3±1.2)个月]。术后2周、3个月、12个月VAS[(3.6±0.8)分、(2.1±0.4)分、(1.8±0.3)分]低于术前[(8.3±1.6)分](P<0.05),UCLA肩关节功能评分[(31.2±1.5)分、(33.6±0.8)分、(34.6±0.5)分]高于术前[(28.4±2.3)分](P<0.05),MEPS[(80.2±3.4)分、(93.4±2.2)分、(96.4±3.5)分]高于术前[(60.5±4.5)分](P<0.05).末次随访时UCLA肩关节功能评分、MEPS均为优。结论前外侧入路MIP0治疗肱骨干中下段骨折,尤其是对于骨折线相对偏骨干远端的骨折,患者术后疼痛明显缓解,肩肘关节活动度显著改善,功能恢复良好。
Objective To investigate the clinical effect of minimally invasive plate osteosynthesis(MIPO)through anterolateral approach in treatment of middle-distal humeral shaft fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 21 patients with middle-distal humeral shaft fracture admitted to 7th Medical Center of Chinese PLA General Hospital from August 2015 to March 2018,including 12 males and 9 females,aged 18~68 years[(31.3±3.6)years].All were closed fracture.According to AO classification,the fracture were classified as type A in 6 patients,type B in 10 and type C in 5.All patients were treated with anterolateral minimally invasive plate fixation.The operation time,intraoperative blood loss and hospital stay were recorded.The fracture healing was observed after operation.The visual analogue scale(VAS),University of California at Los Angeles(UCLA)shoulder rating scale,and Mayo elbow performance score(MEPS)were used to evaluate the effectiveness before operation and at 2 weeks,3 months and 12 months after operation.Results All patients were followed up for 12-26 months[(18.2±2.4)months].The operation time was 50-82 minutes[(68.2±19.4)minutes],with intraoperative blood loss of 40-95 ml[(60.2±21.3)ml].The hospital stay was 6-16 days[(6.8±1.2)days].There was no iatrogenic vascular or nerve injury during operation.The patients with radial nerve injury before operation were all adventitia contusion.The nerve function returned to normal within 3 months after operation.All fractures were healed within 5-10 months[(5.3±1.2)months].At 2 weeks,3 months and 12 months after operation,the VAS[(3.6±0.8)points,(2.1±0.4)points,(1.8±0.3)points.]was lower than that before operation[(8.3±1.6)points](P<0.05);UCLA shoulder rating scale[(31.2±1.5)points,(33.6±0.8)points,(34.6±0.5)points]was higher than that before operation[(28.4±2.3)points](P<0.05);and MEPS[(80.2±3.4)points,(93.4±2.2)points,(96.4±3.5)points]was higher than that before operation[(60.5±4.5)points](P<0.05).At the last follow-up,the UCLA shoulder rating scale and MEPS showed excellent results.Conclusion For middle and lower humeral shaft fracture especially for the fracture line relatively distal to the shaft,MIPO technique through anterolateral approach can attain satisfactory results in terms of pain,range of motion of shoulder and elbow joint,and joint function.
作者
征华勇
高杰
郭永智
王晓伟
张建政
李绍光
刘智
孙天胜
Zheng Huayong;Gao Jie;Guo Yongzhi;Wang Xiaowei;Zhang Jianzheng;Li Shaoguang;Liu Zhi;Sun Tiansheng(Department of Orthopedics,7th Medical Center of Chinese PLA General Hospital,Beijing 100700,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第6期549-554,共6页
Chinese Journal of Trauma
基金
军委后勤保障部项目(BLJ18J006)。
关键词
肱骨骨折
骨折固定术
内
骨板
微创技术
Humeral fractures
Fracture fixation,internal
Bone plates
Minimally invasive technique
作者简介
通信作者:孙天胜,Email:suntiansheng-@163.com,电话:13501072165。
