肱骨干骨折钢板内固定的入路选择与疗效分析

目的不同部位肱骨干骨折钢板内固定的入路选择及疗效分析。方法对2012年9月至2016年2月收治的28例肱骨干骨折患者的临床资料进行回顾性分析。按AO分型，其中A型11例、B型14例、C型3例；根据骨折部位分为上1／3骨折9例，中1／3骨折10例，下1／3骨折9例，分别采用上臂外侧、前侧、后正中入路切开复位钢板内固定术，并于术后6个月采用Rodriguez标准评定疗效。结果28例手术均顺利完成，手术时间（75±9．4）min，出血量（180±22．8）ml，术中无重要血管、神经损伤，术后切口一期愈合。患者均获随访6-12个月，平均10个月，骨折愈合时间4-6个月，无骨折不愈合及内固定松动、断裂；术后6个月Rodriguez评分：优24例（85．7％），良4例（14.3％）。结论肱骨干骨折因骨折部位不同采用相应入路，可清晰地显露复位骨折并便于钢板置入固定，并能有效避免桡神经医源性损伤。

Objective Postoperative assessment for different surgical approachs in treating humeral shaft fracture with plate internal fixation. Methods A total of 28 cases of humeral shaft fracture from 2012.9 to 2016.2 were analyzed. According to AO classification, there were 11 cases in type A, 14 in type B and 3 in type C, while 9 cases of fracture at the proximal 1/3 part of humerus, 10 at middle 1/3 and distal 1/3 based on the site of the fracture and treated with open reduction and internal fixation in the lateral, anterior and posterior middle operative approach respectively. All the cases were evaluated in six months according to the Rodriguez system. Results All the 28 cases were finished successfully with an average time of （75 ± 9.4） min and intraoperatve blood loss of （180 ± 22.8） ml, no major nerves or vessels were injuried during the operation and all the incisions were healed by first intention. Follow-ups were carried out within 6-12 months （ average of 10 ） and healing of fractures were found within 4-6 months. No nonunion of fracture, looseness or breakage of internal fixation were found during the follow-ups. The scoring results according to Rodriguez system were as follows： 24 cases excellent （ 85.7% ） and 4 good. Conclusion Different operative approachs should be applied according to the site of fracture, which can make fracture site exposed more clearly and implants placed more conveniently, thus avoiding iatrogenic injury effectively.