微创锁定接骨板技术治疗复杂肱骨干骨折

Minimally Invasive Plate Osteosynthesis in the Treatment of Complex Humeral Shaft Fractures

目的探讨肱骨前方入路锁定钢板微创治疗复杂肱骨干骨折的疗效。方法 2005年1月～2008年12月利用微创锁定接骨板技术治疗26例复杂肱骨干骨折(骨折类型采用AO分型标准:B型骨折15例,C型骨折11例),采用闭合牵引复位,肱骨前侧微创切口,钢板经皮下潜行插入,跨越骨折端,钢板置于肱骨干前表面,经皮进行锁钉螺钉固定。UCLA标准评估肩关节功能。结果 26例骨折术后3～5个月,平均4个月愈合。2例出现桡神经损害症状,分别于术后2周、3.5月内神经功能恢复;1例因钢板过高产生肩关节撞击症状,骨折愈合后内固定取出,症状消失。26例术后随访18～36个月,平均26个月,术后6个月肩关节功能UCLA评分优良率92.3%(24/26)。结论微创肱骨前方置入锁定钛板技术是治疗复杂性肱骨干骨折的一种安全有效的方法。

Objective To study the effect of minimally invasive plate osteosynthesis in the treatment of complex humeral shaft fractures via the anterior approach. Methods From January 2005 to December 2008, a total of 26 patients with complex humeral shaft fractures （type B 15 cases and type C 11 cases, according to AO classification） were treated in our hospital. All the patients received locking compression plates via a minimally invasive approach. A mini anterior incision was made at the anterior humerus, so that the plate could be inserted. And then, over the fracture site, the plate was placed and fixed anterior to the humeral shaft. Functional recovery of the shoulder joint was assessed using the UCLA scoring systems. Results In the patients, the fracture was healed in 3 - 5 months after the operation （ mean, 4 months）. Two of the patients showed symptoms of musculospiral nerve injury during the period, and then recovered in 2 weeks and 3.5 months postoperatively. One case developed shoulder impingement syndrome; the symptom disappeared after the plate was removed. Follow-up was carried out on 26 cases for 18 to 36 months （mean, 26 months）. UCLA scoring system recovered an excellent-good rate of 92.3% （24/26） in shoulder function. Conclusions Minimally invasive plate osteosynthesis with locking compression plate is an effective and safe procedure for complex humeral shaft fractures.