前方入路微创接骨板接骨术治疗肱骨干中段骨折

Anterior minimally invasive plate osteosynthesis for treatment of middle humeral shaft fracture

目的评价前方入路微创接骨板接骨术（MIPO）治疗肱骨干中段骨折的效果。方法选择2011年11月-2014年3月采用前方入路MIPO治疗肱骨干中段骨折患者10例（MIPO组）作为研究对象，以2010年10月—2014年3月采用切开复位内固定（ORIF）治疗肱骨干中段骨折患者26例作为对照（ORIF组），两组均采用4．5mm锁定加压钢板（LCP）固定。观察并比较两组手术时间、术中透视次数、植骨率、术中出血量、术后引流量、住院时间、骨折愈合时间和并发症。结果MIPO组和ORIF组术中出血量、术中透视次数、住院时间分别为[（93．5±25．6）ml、（325．3±158．3）m1]、[（13．2±6．1）次、4．0（0—6．0）次]、[（11．9±1．7）d、（18．0±4．7）d]（P〈0．05）；MIPO组无植骨，术后无引流量；ORIF组植骨率为54％，术后引流量为（120．4±69．6）ml（P〈0．05）。MIPO组和ORIF组的手术时间、骨折愈合时间、术后并发症发生率分别为[（79．0±22．0）min、（97．5±30．8）min]、[（15．2±2．5）周、（18．2±4．8）周]、（10％、23％）（P〉0．05）。结论前方入路MIPO具有创伤小、出血少、神经损伤风险低、骨折愈合率高等优点，是治疗肱骨干中段骨折的有效方法之一。

Objective To evaluate the effect of anterior minimally invasive plate osteosynthesis （MIPO） for treatment of middle humeral shaft fracture. Methods From November 2011 to March 2014, 10 cases of middle humeral shaft fracture were treated using MIPO via the anterior approach （MIPO group）. Another 26 cases treated by open reduction and internal fixation （ORIF） of the middle humeral shaft fracture between October 2010 and March 2014 were included as controls （ ORIF group）. Fracture fixation using the 4. 5 mm locking compression plate （LCP） was performed in both groups. Parameter meas- urements included operative time, intraoperative fluoroscopy times, grafting rate, intraoperative blood loss, postoperative drainage, hospital stay, bone healing time and complications. Results MIPO and ORIF groups differed significantly with respect to intraoperative blood loss [ （93.5 ± 25.6 ） ml vs （ 325.3 ± 158.3）ml], intraoperative fluoroscopy times [ （ 13.2 ± 6. 1 ） vs 4.0 （0 - 6.0） ] and hospitalization [ （ 11.9 ± 1.7 ） days vs （ 18.0 ± 4.7 ） days ] （ P 〈 0.05 ）. Bone grafting and drainage were not performed in MIPO group, while bone grafting rate was 54% and postoperative drainage volume was （120. 4 ± 69. 6 ） ml in ORIF group （ P 〈 0.05 ）. MIPO and ORIF groups were comparable with respect to operative time [ （ 79. 0 ± 22. 0） min vs （ 97.5 ± 30. 8 ） min ], bone healing time [ （ 15.2 ± 2. 5 ） weeks vs （ 18. 2 ± 4. 8） weeks ] and postoperative complications （ 10% vs 23% ） （ P 〉 0. 05 ）. Conclusion Anterior MIPO is an effective procedure for treatment of middle humeral shaft fracture, with advantages of small trauma, less bleeding, low risk of nerve injury and high rate of fracture healing.