微创接骨板接骨术治疗肱骨干骨折的疗效观察

Effect of minimally invasive plate osteosynthesis on humeral shaft fractures

背景:肱骨干骨折是常见上肢损伤之一。微创接骨板接骨术(minimally invasive plate osteosynthesis,MIPO)具有创伤小、骨折愈合率高等优点,多用于治疗长骨骨折,尤其是下肢长管状骨。然而,由于上臂解剖学特殊性,使其在肱骨干骨折的治疗中受到限制。目的:比较切开复位内固定(open reduction and internal fixation,ORIF)与MIPO治疗肱骨干骨折的疗效,并评价其风险。方法:2012年2月至2017年2月,手术治疗肱骨干骨折患者61例;其中,行ORIF31例(ORIF组),MIPO 30例(MIPO组)。记录手术时间、X线暴露时间、骨折愈合时间、并发症,DASH评分评定患肢功能。结果:两组一般资料比较,差异无统计学意义(P>0.05);均获得骨折良好复位及内固定。术后ORIF组出现医源性桡神经损伤及骨折延迟愈合各2例;两组各合并浅表感染1例;无内固定失效、深部感染、骨折畸形愈合与不愈合。两组手术时间、并发症差异无统计学意义(P>0.05)。MIPO组X线暴露时间长于ORIF组(P<0.01)、骨折愈合时间短于ORIF组(P<0.05)。术后6、12周,MIPO组DASH评分优于ORIF组(P<0.05,P<0.01);术后6个月及末次随访时,DASH评分提示功能恢复均良好,组间差异无统计学意义(P>0.05)。结论:ORIF与MIPO均可用于治疗肱骨干骨折,获得骨性愈合、恢复肢体功能。应用MIPO技术骨折愈合时间更短、功能恢复更快,切口更美观。然而,应用微创技术,X线暴露时间长,需注意手术人员及患者防护。

Background： Humeral shaft fracture is one of the common upper limb injuries. Minimally invasive plate osteosynthesis（MIPO） has been successful in managing various long tubular bone fractures of lower extremity due to the biologic superiority with less stripping and higher bone union rate. In the upper limb, however, MIPO technique has not been commonly used because of the complex anatomy of the neurovascular structures. Objective： To compare the clinical and radiologic results and hazards of open reduction and internal fixation（ORIF） and MIPO in treatment of humeral shaft fractures.Methods： From February 2012 to February 2017, 61 patients with humeral shaft fractures were treated with ORIF（ORIF group, 31 cases） or MIPO（MIPO group, 30 cases）. The operation time, radiation exposure time, bone healing time, and intra-and postoperative complications were recorded. The upper limb functions were evaluated according to the DASH scoring system. Results： There was no significant difference in the demographic data of the patients between the two groups（P〉0.05）. Postoperative X-ray photography confirmed satisfactory fracture reduction and internal fixation in all patients. Complications included 2 partial radial nerve palsies（ORIF group）, 2 delayed unions（ORIF group）, and 2 superficial infections（1 case in each group）. Implant failure, deep infection, malunion and nonunion were not observed in any patients. There was no significant difference in the operation time or incidence of the complications between two groups（P〉0.05）. The radiation exposure time was longer（P〈0.01）, whereas the bone healing time was shorter（P〈0.05） in the MIPO group than those in the ORIF group. Although excellent functional outcomes were achieved in both groups at 6 months postoperatively and final visit（P〉0.05）, the upper limb functions evaluated with DASH scores in the MIPO group were superior to those in the ORIF group at 6 and 12 weeks follow-up（P〈0.05, P〈0.01, respectively）. Conclusions： This study confirms a high overall rate of bone union and excellent functional outcomes in both MIPO and ORIF groups. MIPO results in faster union, faster rehabilitation, more aesthetic incision, and should be considered as an alternative option to the conventional ORIF technique. However, the faculty and patient should be protected against radiation exposure during fracture management.