螺旋形桥接组合式内固定系统经皮内固定治疗肱骨中上段长劈裂骨折

Percutaneous fixation with helical bridge combined fixation system for long split fractures involving the middle and upper humerus

目的总结螺旋形桥接组合式内固定系统(bridge combined fixation system,BCFS)经皮内固定治疗肱骨中上段长劈裂骨折的疗效。方法 2018年2月—2020年2月,收治15例肱骨中上段长劈裂骨折。男6例,女9例;年龄37~82岁,平均62岁。致伤原因:摔伤7例,高处坠落伤3例,交通事故伤5例。肱骨干部骨折AO分型:A型4例,B型9例,C型2例;骨折均累及肱骨近端,肱骨近端骨折Neer分型:一部分骨折11例,二部分骨折4例。受伤至手术时间1~7 d,平均3.2 d。术中骨折闭合复位(9例)或延长切口复位(6例)后,采用螺旋形BCFS经皮内固定。记录手术时间、术中出血量以及术后切口愈合、骨折愈合情况。采用ConstantMurley评分评价肩关节功能,Mayo评分评价肘关节功能。结果手术时间55~175 min,平均76.5 min;术中出血量80~300 mL,平均185.5 mL。术后切口均Ⅰ期愈合,无桡神经损伤症状发生。患者均获随访,随访时间12~23个月,平均16个月。骨折均达临床愈合,愈合时间12~20周,平均14.5周。术后1年,肩关节功能参照Constant-Murley评分患侧为(88.7±7.6)分,与健侧(90.8±8.3)分比较,差异无统计学意义(t=1.421,P=0.052);肘关节功能参照Mayo评分患侧为(97.6±6.5)分,与健侧(97.7±7.3)分比较,差异无统计学意义(t=0.433,P=0.913)。结论螺旋形BCFS可以避开三角肌止点及远端桡神经,无需对桡神经暴露,适用于累及肱骨近端的肱骨中上段长劈裂骨折。

Objective To evaluate the effectiveness of percutanous fixation with helical bridge combined fixation system(BCFS) for treatment of long split fractures involving the middle and upper humerus. Methods Between February 2018 and February 2020, 15 patients of long split fractures involving the middle and upper humerus were treated. There were 6 males and 9 females, with an average age of 62 years(range, 37-82 years). The fractures were caused by slipping in 7 cases, falling from height in 3 cases, and traffic accident in 5 cases. According to AO classification, the shaft fractures were rated as type A in 4 cases, type B in 9 cases, and type C in 2 cases. And all fractures extended to proximal humerus;and the proximal fractures were rated as one-part fracture in 11 cases and two-part fracture in 4 cases according to Neer classification. The interval between injury and operation was 1-7 days(mean, 3.2 days). Nine patients underwent closed reduction and 6 patients underwent open reduction after lengthening the incisions. All fractures were percutaneously internal fixated with helical BCFS after reduction. The operation time, intraoperative blood loss, incision healing, and fracture healing were recorded. Constant-Murley score was used to evaluate shoulder joint function, and Mayo score was used to evaluate elbow joint function. Results The operation time ranged from 55 to 175 minutes, with an average of 76.5 minutes;the intraoperative blood loss ranged from 80 to 300 mL, with an average of 185.5 mL. All incisions healed by first intention, without infection or radial nerve injury. All patients were followed up 12-23 months,with an average of 16 months. The fractures all reached clinical healing, and the healing time was 12-20 weeks, with an average of 14.5 weeks. At 1 year after operation, the Constant-Murley score of the affected side was 88.7±7.6, and there was no significant difference when compared with that of the healthy side(90.8±8.3)(t=1.421, P=0.052). According to the elbow Mayo score, the score of the affected side was 97.6±6.5, and there was no significant difference when compared with the healthy side(97.7±7.3)(t=0.433, P=0.913). Conclusion The helical BCFS can avoid the dissection of deltoid insertion and prevent the iatrogenic radial nerve injury. With satisfied effectiveness, it is suggested for minimally invasive surgical treatment of long split fractures involving the middle and upper humerus.