前侧入路与外侧入路微创钢板固定肱骨干骨折疗效比较

COMPARISON OF EFFECTIVENESS BETWEEN ANTERIOR AND LATERAL APPROACHES OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS IN TREATMENT OF HUMERAL SHAFT FRACTURES

目的 比较前侧入路与外侧入路微创钢板内固定术（minimally invasive plate osteosynthesis,MIPO）治疗肱骨干骨折的疗效。方法 回顾分析2010年1月-2012年12月符合选择标准的采用MIPO治疗的35例肱骨干骨折患者临床资料,其中前侧入路17例（A组）,外侧入路18例（B组）。两组患者性别、年龄、致伤原因、骨折分型、受伤至手术时间等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。比较两组患者手术时间、术后并发症、骨折愈合时间、肩肘关节活动范围;采用美国加州大学洛杉矶分校（UCLA）肩关节功能评分标准和Mayo肘关节功能评分标准评价肩肘关节功能。结果 A、B组手术时间分别为（91.35±8.00）min和（95.56±7.92）min,差异无统计学意义（t=—1.561,P=0.128）。两组患者术后切口均Ⅰ期愈合;A组无医源性桡神经麻痹发生,B组有2例（11.1%）存在一过性医源性桡神经麻痹,两组发生率比较差异无统计学意义（χ2=2.003,P=0.486）。患者均获随访,A组随访时间11～24个月,平均15.4个月;B组10～23个月,平均16.8个月。X线片示两组骨折均获骨性愈合,A组愈合时间为（13.5±2.1）周,B组为（14.0±2.2）周,差异无统计学意义（t=—0.696,P=0.491）。末次随访时A、B组UCLA肩关节功能评分分别为（33.4±1.9）分和（30.6±2.0）分,Mayo肘关节功能评分分别为100分和（96.4±2.8）分,两组比较差异均有统计学意义（t=4.231,P=0.000;t=5.243,P=0.000）。结论 采用MIPO治疗肱骨干骨折时,前侧入路较外侧入路更为安全,术后肩肘关节功能也优于外侧入路。

Objective To compare the effectiveness of anterior and lateral approaches of minimally invasive plate osteosynthesis （MIPO） in the treatment of humeral shaft fractures. Methods The clinical data were retrospectively analyzed and compared from 35 cases of humeral shaft fractures between January 2010 and December 2012. The patients underwent MIPO by anterior approach in 17 patients （group A） and by lateral approach in 18 patients （group B）. There was no significant difference in gender, age, injury causes, type of fractures, and time from injury to operation between 2 groups （P 〉 0.05）. The operation time, fracture healing time, intra- or postoperative complications, and shoulder and elbow range of motion （ROM） values were recorded and analyzed. The functions of the affected shoulder and elbow were assessed with the University of California Los Angeles （UCLA） and Mayo elbow performance score system respectively. Results The operation time was （91.35 ＋ 8.00） minutes and （95.56 ＋ 7.92） minutes in groups A and B respectively, showing no significant difference （t=- -1.561, P=0.128）. Incision healed by first intention in all patients of 2 groups. No iatrogenic radial nerve palsy occurred in group A, 2 cases had postoperative iatrogenic radial nerve palsy in group B, showing no significant difference （P=0.486）. The patients were followed up 15.4 months on average （range, 11-24 months） in group A and 16.8 months on average （range, 10-23 months） in group B. The X-ray films showed bony healing in all patients. The fracture union time was （13.5 ± 2.1） weeks in group A and （14.0 ± 2.2） weeks in group B, showing no significant difference （t= -0.696, P=0.491）. The UCLA scores were 33.4 ± 1.9 in group A and 30.6 ± 2.0 in group B, and the Mayo elbow performance scores were 100 in group A and 96.4 ± 2.8 in group B; all showed significant differences （t=-4.231, P=0.000; t=-5.293, P=O.O00）. Conclusion Good clinical outcomes could be obtained when humeral shaft fractures are treated with MIPO either by anterior approach or by lateral apporach. However, anterior approach could offer better shoulder and elbow functional results.