经前侧入路应用肱骨近端锁定钢板结合微创技术治疗肱骨近中段粉碎骨折的疗效

Effect of minimally invasive anterior osteosynthesis plating with the proximal humerus internal locking system for proximal humeral shaft fractures

目的探讨经肱骨前侧入路应用肱骨近端锁定钢板结合微创技术治疗肱骨近中段粉碎骨折的疗效。方法回顾分析2014年6月至2017年9月唐山市第二医院创伤骨科收治的29例肱骨近中段粉碎骨折患者的病历资料。其中,男19例,女10例;平均年龄39.5(25~64)岁。采用上肢功能评分系统(DASH)评估患肢功能情况,采用Mayo肘关节功能评分系统(MEP)评估预后。结果29例患者术后均获得随访,平均随访时间15.4(12~24)个月。所有患者均获得骨性愈合,肱骨骨折愈合时间平均3.6(3~5)个月。随访至术后12个月,未发现感染、医源性神经损伤、骨折不愈合、内固定断裂失效等并发症。DASH评分平均4.6(0~16)分。Mayo评分:优28例,良1例。结论经肱骨前侧入路应用肱骨近端锁定钢板结合微创技术治疗肱骨近中段粉碎骨折的临床疗效显著,骨折愈合率高,且近期随访未见肱骨骨折不愈合及医源性神经损伤等情况。

Objective To investigate clinical effect of minimally invasive anterior osteosynthesis plating with the proximal humerus internal locking system for proximal humeral shaft fractures. Methods Data including 29 patients with proximal humeral shaft fractures in Department of Orthopaedics, The Second Hospital of Tangshan from June 2014 to September 2017 were reviewed. Among these patients: 19 males and 10 females aged 25 to 64 (mean 39.5) years. All patients were treated with minimally invasive anterior osteosynthesis plating for the proximal humeral shaft fractures. The function of the injured limb was assessed by disabilities of the arm, shoulder and hand score(DASH), and the prognosis was assessed by Mayo elbow performance score (MEP). Results All of the 29 patients were followed up for 12 to 24 months with an average of 15.4 months. All patients obtained good fracture union. The mean time of the fracture union was 3.6 months (ranged 3-5 months). The complications such as osteomyelitis, iatrogenic nerve injury, nonunion and metal failure were not ccurred until follow-up time of 12 months after surgery. At follow-up time of 12 months after surgery , the mean DASH score were 4.6 scores (ranged 0-16 scores). The MEP score: 28 cases were excellent, one case were good. Conclusion The treatment of proximal humeral shaft fractures by minimally invasive anterior osteosynthesis plating with the proximal humerus internal locking system is effective , and it can obtain higher fracture union rate. No nonunion and iatrogenic nerve injury occurred.