应用前外侧桡神经探查入路的微创钢板内固定手术治疗肱骨干远端关节外骨折

MIPO technique with anterolateral radial nerve exploration approach for extra-articular fractures of distal humeral shaft

目的评估前外侧桡神经探查入路微创钢板内固定(minimally invasive plate osteosynthesis,MIPO)手术治疗肱骨干远端关节外骨折的疗效及对桡神经的安全性。方法 2010年4月至2016年6月大连医科大学附属第一医院采用前外侧桡神经探查MIPO手术治疗28例肱骨干远端关节外骨折。记录患者的基本资料,臂、肩、手功能障碍评分(disabilities of the arm,shoulder and hand score,DASH),Mayo肘关节功能评分,肘关节活动度,瘢痕长度,术后并发症,并评估临床疗效。结果所有骨折完全愈合,平均愈合时间为3.5个月。其中1例出现骨折延迟愈合(3.6%),愈合时间为9个月。没有骨折不愈合、医源性神经损伤或者内固定失效等并发症出现。平均DASH评分6.6分,所有患者的Mayo评分均为优或良。平均瘢痕长度为6.8 cm,其中最短瘢痕为4.5 cm,最长为8 cm。在远端骨块使用2或3枚螺钉对临床结果没有差异。结论前外侧入路桡神经探查MIPO手术治疗肱骨干远端关节外骨折会得到可靠的骨折愈合率,较少的医源性神经损伤,较小的创伤和手术瘢痕,良好的术后功能。

Background The extra-articular fracture of distal 1/3 humeral shaft accounts for 16%of humeral shaft fractures.There are some difficulties in the clinical treatment of this fracture,and the optimal treatment is still controversial.The conservative treatment with functional brace can achieve higher fracture healing rate and acceptable limb function.However,the disadvantage is that the affected limb needs long time immobilization,which brings higher rate of malunion and joint stiffness.In order to restore good fracture force line and achieve reliable fixati on effect for early functional exercises,many doctors advocate open reduction and internal fixation as treatment method.There is a higher risk of iatrogenic radial nerve injury due to the need for extensive exposure of the radial nerve during the procedure via the posterolateral approach and lateral approach.The traditional incision will need extensive dissection of soft tissue and ultimately leave a long surgical scar that is unsightly.