摘要
目的通过后内侧入路与常用的前外侧入路、后侧正中入路治疗肱骨中下段骨折,比较其临床疗效。方法回顾性分析2021年1月-2023年12月中南大学湘雅二院桂林医院及中国人民解放军第924医院收治的68例肱骨中下段骨折患者病例资料。其中前外侧入路组23例(A组)、后侧正中入路组20例(B组)和后内侧入路组25例(C组)。三组患者在性别、年龄、受伤至手术时间、住院天数等一般资料比较中,差异均无统计学意义(P>0.05),三组可以比较。记录并比较三组手术时间、术中出血量、开始功能训练时间、骨折愈合时间、骨折近端螺钉固定数目、术后石膏使用率及尺、桡神损伤率、末次随访肩、肘关节功能的优良率等方面的差异。结果68例均顺利完成手术且均获得12~24个月随访。(1)三组患者手术时间比较差异无统计学意义(P>0.05);(2)C组患者术中出血量、开始功能训练时间、骨折愈合情况均优于其他两组,且差异有统计学意义(P<0.05);(3)三组患者近端打入的螺钉数目比较,差异有统计学意义(P<0.05);(4)C组石膏使用率显著低于A组(30.4%)和B组(45.0%),差异有统计学意义(P<0.05);(5)三组总共发生7例桡神经损伤,C组桡神经损伤发生率低于A组(71.4%)和B组(28.6%),且差异有统计学意义(P<0.05);三组患者术后均未发生尺神经损伤症状;(6)Jupiter肘关节功能评分C组(96%)的优良率显著高于A组(69.6%)和B组(75.0%),差异有统计学意义(P<0.05);所有随访患者肩关节Neer评分均为优。结论后内侧入路可有效避开桡神经,避免破坏肱三头肌,根据骨折位置可选择一块钢板后侧固定或者两块钢板垂直固定,早期进行肩肘关节的功能训练,骨折愈合快,为临床手术治疗肱骨中下段骨折提供一个值得推广的入路方式。
Objective To compare the clinical efficacy of treating middle and lower humerus fractures by posterior medial approach with the commonly used anterolateral approach and posterior midline approach.Methods Sixty-eight patients with middle and lower humerus fractures admitted to our hospital and other hospitals from January 2021 to December 2023 were retrospectively analyzed.Including an anterolateral approach group,twenty-three patients(Group A),a posterior midline approach group,twenty patients(Group B),and a posterior medial approach group,twenty-five patients(Group C).Comparison of the general information of patients in the three groups in terms of gender,age,time from injury to surgery,and number of days of hospitalization and other differences were not statistically significant(P>0.05),and the three groups could be compared.Differences in operation time,intraoperative bleeding,time to start functional exercise,fracture healing time,number of proximal screw fixations of the fracture,postoperative plaster utilization rate,ulnar and radial nerve injury rate,and excellent rate of shoulder and elbow function at the last follow-up were recorded and compared among the three groups.Results All 68 patients completed the surgery and were followed up.(1)There was no statistically significant difference in the operation time among the three groups(P>0.05);(2)Group C patients had better intraoperative bleeding,time to start functional exercise,and fracture healing than the other two groups,and the difference was statistically significant(P<0.05);(3)There was a statistically significant difference in the number of proximal screws driven in the three groups(P<0.05);(4)The plaster utilization rate of group C was significantly lower than that of group A(30.4%)and group B(45%),and the difference was statistically significant(P<0.05);(5)A total of 7 cases of radial nerve injury occurred in the 3 groups,and the incidence of radial nerve injury in group C was lower than that in group A(71.4%)and group B(28.6%),and the difference was statistically significant(P<0.05);none of the patients in the 3 groups had the symptoms of ulnar nerve injury after the operation;(6)The Jupiter elbow function score of group C(96%)was significantly better than that of group A(69.6%)and group B(75%),and the difference was statistically significant(P<0.05);Neer score of the shoulder joint was excellent in all the follow-up patients.Conclusion Posteromedial approach can effectively avoid the radial nerve and avoid destroying the triceps brachii muscle;according to the fracture location,we can choose 1 plate for posterior fixation or two plates for vertical fixation;early functional exercise for shoulder and elbow joints,and fast fracture healing,which is a good access route worth of popularizing for surgical treatment of lower middle humerus fracture.
作者
唐继全
闫玉栋
陈程
杨建平
刘荣林
滕涛
TANG Jiquan;YAN Yudong;CHEN Cheng(Department of Orthopedics,Guilin Hospital,Xiangya Second Hospital of Central South University,Guilin,Guangxi Zhuang Autonomous Region,541001,China)
出处
《实用手外科杂志》
2025年第3期283-288,共6页
Journal of Practical Hand Surgery
基金
桂林市科技计划项目(项目编号:20220139-12-2)。
关键词
手术入路
肱骨中下段骨折
内固定
疗效
Surgical approach
Lower middle humerus fracture
Internal fixation
Efficacy
作者简介
唐继全(1973-),男,主任医师。
