锁定加压钢板微创固定治疗肱骨干骨折的初步报告

Minimally invasive plate osteosynthesis of humeral shaft fractures with locking compression plate: short-term results in 17 cases

目的探讨锁定加压钢板(LCP)经肱骨前侧入路微创穿皮固定治疗肱骨干骨折的方法及疗效。方法2004年2月-2005年1月间,使用LCP经肱骨前侧入路微创穿皮固定治疗肱骨干骨折17例,男12例,女5例;年龄18-75岁(平均48岁)。根据AO分型:A型3例,B型10例,C型4例。结果经14-25个月(平均19．1个月)随访,17例患者全部愈合。骨折愈合时间为9-14周(平均11．3周)。末次随访时,肩关节前屈135°-180°(平均174°),后伸20°-40°(平均38°),外展70°-90°(平均87°);肘关节前屈115°-135°(平均133°),后伸-10°-0°(平均-1°);手臂肩残疾问卷表(DASH)评分6-44分(平均11分)。术后3例出现并发症:1例GustiloⅢB型开放性骨折发生浅表感染,经保守治疗后痊愈;1例术后出现一过性桡神经麻痹,3个月后症状完全消退;另有1例出现明显的肩肘关节功能障碍。无继发骨折移位及内固定物失效或断裂。结论LCP经肱骨前侧入路微创穿皮固定治疗肱骨干骨折可以提供稳定的固定,骨折愈合率较高,神经血管结构相对安全;更适合于粉碎性或骨质较差的肱骨干骨折。

Objective To evaluate minimally invasive plate osteosynthesis （MIPO） technique in the treatment of humeral shaft fractures using locking compression plate （LCP）. Methods Between February 2004 and January 2005, 17 consecutive patients with 17 humeral shaft fractures were treated with LCP by MIPO technique. There were 12 men and 5 women with a mean age of 48 years （range, 18 to 75）. According to AO classification, three fractures were type 12-A, 10 type 12-B, and four type 12-C. Results The mean duration of follow-up was 19. 1 months （range 14 to 25） . Union occurred in all patients with a mean healing time of 11.3 weeks （range 9 to 14） . With regard to ROM of the shoulder, the mean flexion was 174 degrees（range, 135 to 180 ）, the mean extension was 38 degrees（range, 20 to 40）, and the mean abduction was 87 degree（range, 70 to 90）. For the elbow, the mean flexion was 133 degree（range, 115 to 135）, the mean extension was - 1 degree（range, - 10 to 0）. Using the patient-rated functional questionnaire, the mean DASH（disabilities of the arm, shoulder and hand） score of 11 points（range, 6 to 44） at the latest follow-up indicated a mild to moderate impairment. There were three postoperative complications. One superficial infection occurred in a Gustilo type Ill B open fracture and was uneventfully healed with conservative managements. One patient experienced transient radial nerve palsy which showed complete remission within 3 months. The third one demonstrated a dysfunction of shoulder and elbow. There were no cases of secondary malalignment or late hardware failure in this cohort. Conclusions Internal fixation using LCP in MIPO can attain a stable fixation, a high union rate as well as a low complication rate. The neurovascular structures may be at less risk of iatrogenic injuries through the anterior approach. It may be considered a reliable and efficient method for humeral shaft fractures, especially for comminuted ones and those with poor bone quality.