闭合复位经皮双针内固定治疗肱骨干多段骨折

Closed reduction and percutaneous double K wires internal fixation for the treatment of multisegmental fracture of humeral shaft

目的:探讨闭合复位经皮双针内固定术治疗肱骨干多段骨折的临床疗效。方法 :2009年1月至2015年4月,共收治27例肱骨干多段骨折患者,其中男10例,女17例;年龄26~81岁,平均52岁;伤后至就诊时间2 h^6 d,平均1.5 d,均采用闭合复位经皮穿针内固定治疗。观察患者的手术时间、术中出血量、住院时间、骨折愈合时间及并发症情况,并采用Constant-Murley肩关节评分评价肩关节功能恢复状况。结果:所有患者获得随访,时间12~24周,平均16周。手术时间20~40 min,平均28 min;术中失血量5~25 ml,平均10 ml;住院时间3~5 d,平均3.5 d。骨折均获得骨性愈合,愈合时间12~22周,平均14周。术后1例患者针尾突出,出现局部刺激症状,骨折愈合拔出克氏针后症状消失;1例针尾退出后并发局部感染,经抗炎治疗后痊愈。根据Constant-Murley肩关节功能评分,总分为89.1±2.7,其中优10例,良15例,可2例。结论:闭合复位经皮双针内固定治疗肱骨干多段骨折具有手术操作简单、出血量少、创伤小、并发症少、肩肘功能恢复较好的优点。需要注意的是闭合复位经皮双针内固定术不能有效对抗旋转和提供轴向稳定,需要配合外固定及三角巾悬吊等有效辅助措施。

Objective： To observe the clinical effects of closed reduction and percutaneous double K-wires internal fixation in treating multisegmental fracture of humeral shaft.Methods： From January 2009 to April 2015,27 patients with multisegmental fracture of humeral shaft were treated with closed reduction and percutaneous double K-wires internal fixation,including 10 males and 17 females,ranging in age from 26 to 81 years with an average of 52 years;the disease course ranged from 2 hours to 6 days with an average of 1.5 days. Operative time,intraoperative blood loss,hospital stay,fracture healed time,complications were observed and recovery of shoulder joint function was evaluated by Constant-Murley shoulder score.Results： All the patients were followed up from 12 to 24 weeks with an average of 16 weeks. Operative time was 20 to 40 min with an average of 28 min;intraoperative blood loss was 5 to 25 ml with an average of 10 ml;hospital stay was 3 to 5 days with an average of 3.5 days. All fractures got bone healing and healed time was 12 to 22 weeks with average of 14 weeks. Postoperatively 1 case complicated with wire tail bulging and local irritation symptoms,and the symptoms disappeared when the wire was removed out after the fracture healing;1 case complicated with local infection after wire tail disengaging,and recovered through anti-septic treatment. According to the Constant-Murley standard of shoulder joint function,10 cases got excellent results,15 good,2 fair,with scores of 89.1±2.7.Conclusion： Closed reduction and percutaneous double K-wires fixation for the treatment of multisegmental fractures of humeral shaft have advantages of simpler manipulating,less bleeding,less invasive,less complications,and shoulder and elbow joint can obtain good recovery. But closed reduction and percutaneous double K-wires internal fixation cannot be effective against rotation and provide axial stability,the immoblization with a sling or other auxiliary methods should be applied.