MIPO技术中前侧和外侧入路治疗肱骨干骨折的疗效比较

Comparsion of Clinical Effect between Anterior and Antero-lateral Approach of Minimal Invasive Plating Osteosynthesis(MIPO) in Treatment of Humeral Shaft Fractures

目的比较微创钢板接骨术(minimally invasive plating osteosynthesis,MIPO)中前侧入路和外侧入路治疗肱骨干骨折的临床疗效。方法回顾分析2008年10月至2010年10月收治的37例肱骨干骨折患者临床资料,均采用MIPO技术治疗,其中前侧钢板19例(Ⅰ组),外侧钢板18例(Ⅱ组)。Ⅰ组:男8例,女11例,年龄20～65岁,平均43.5岁。左侧8例,右侧11例。AO分型:A型7例,B型7例,C型5例。Ⅱ组:男10例,女8例,年龄28～72岁,平均48.5岁。左侧10例,右侧8例。AO分型:A型5例,B型7例,C型6例。结果所有患者均获随访,Ⅰ组随访时间12～23个月(平均16.9个月);Ⅱ组10～24个月(平均15.8个月)。X线片示两组骨折均获骨性愈合,Ⅰ组骨折愈合时间为(11.4±4.1)周,Ⅱ组为(12.0±3.5)周,差异无统计学意义(P>0.05)。末次随访时,Ⅰ、Ⅱ组参照Constant-Murley肩关节评分分别为(90.1±2.1)分和(86.8±4.6)分,Mayo肘关节评分分别为(97.9±1.5)分和(95.4±2.9)分,两组比较差异均有统计学意义(P<0.05)。结论采用MIPO前侧入路治疗肱骨干中段骨折临床疗效优于外侧入路。

Objective To compare the effectiveness of anterior and antero-lateral approach of minimal invasive plating osteosynthesis（MIPO） in treatment of humeral shaft fractures.Methods The clinical data were retrospectively analyzed and compared from 37 cases with humeral shaft fractures between October 2008 and October 2010.All the patients were divided into 2 groups：19 patients were treated with anterior approach（group Ⅰ） and 18 with antero-lateral approach（group Ⅱ）.In group Ⅰ,there were 8 males and 11 females with an average age of 43.5 years（range 20～65 years）.Eight patients injuried left arm and ten injuried right.Seven fractures were classified as AO type A,7 as type B,and 5 as type C.In group Ⅱ,there were 10 males and 8 females with an average age of 48.5 years（range 28～72 years）.Ten patients injuried left arm and eight injuried right.Five fractures were classified as AO type A,7 as type B,and 6 as type C.There was no significant difference in general data between two groups（P0.05）.Results All the patients were followed up.The X-ray films showed bony healing in all patients.The fracture union time was（11.4±4.1） weeks in group Ⅰ and（12.0±3.5） weeks in group Ⅱ,showing no significant difference（P0.05）.The Constant-Murley End-Result scores were（90.1±2.1） in group Ⅰ and（86.8±4.6） in group B.The Mayo Elbow Performance scores were（97.9±1.5） in group A and（95.4±2.9） in group B.There were all showing significant differences between the groups（P0.05）.Conclusion Good clinical outcomes can be obtained when humeral shaft fractures are treated by either MIPO approaches.However,anterior approach could offer better shoulder and elbow functional results than antero-lateral approach.