肱骨近端锁定内固定系统倒置前方经皮微创与后入路单钢板内固定肱骨干下段骨折的疗效比较

Anterior percutaneous minimally invasive internal fixation with proximal humerus internal locking system inverted versus with a posterior single plate for distal humeral shaft fractures

目的比较肱骨近端锁定内固定系统(PHILOS)倒置前方经皮微创与后入路单钢板内固定治疗肱骨干下段骨折的疗效。方法回顾性分析2018年1月至2021年5月福州市第二医院创伤骨科治疗的65例肱骨干下段骨折患者资料。根据治疗方式不同分为2组:观察组30例(采用PHILOS钢板倒置前方经皮微创内固定),男20例,女10例;年龄(41.5±11.6)岁;骨折按AO分型:A型5例,B型14例,C型11例。对照组35例(采用后入路单钢板内固定),男23例,女12例;年龄(39.9±11.2)岁;骨折按AO分型:A型7例,B型17例,C型:11例。记录并比较两组患者术前一般资料、手术时间、术中出血量、切口总长度、骨折愈合时间,以及末次随访时肩关节视觉模拟评分(VAS)、肘关节VAS评分、Constant-Murley肩关节功能评分(Constant评分)、Mayo肘关节功能评分(MEPS)及并发症发生情况。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。两组患者的手术时间、骨折愈合时间以及末次随访时肩关节VAS评分、肘关节VAS评分、Constant评分、MEPS评分比较差异均无统计学意义(P>0.05)。观察组与对照组患者术中出血量分别为(59.7±26.6)、(165.7±86.4)mL,手术切口总长度分别为(10.7±2.1)、(18.6±2.7)cm,以上项目两组间比较差异均有统计学意义(P<0.01)。观察组术后无桡神经损伤、肌皮神经损伤、切口感染、骨折不愈合。对照组术后出现4例医源性桡神经损伤,切口感染2例,骨折不愈合1例,并发症发生率为20.0%(7/35)。两组并发症发生率比较差异有统计学意义(P<0.01)。结论相比后入路单钢板内固定,PHILOS钢板倒置前方经皮微创内固定治疗肱骨干下段骨折具有软组织损伤小、术中出血少、医源性桡神经损伤风险小等优势。

Objective To compare the clinical effects between proximal humerus internal locking system(PHILOS)inverted and a posterior single plate in the anterior percutaneous minimally invasive internal fixation for distal humeral shaft fractures.Methods A retrospective study was conducted to analyze the data of 65 patients with distal humeral shaft fracture who had been treated from January 2018 to May 2021 at Department of Orthopaedics,The Second Hospital of Fuzhou.The patients were assigned into 2 groups according to different treatment methods.In the observation group of 30 cases subjected to anterior percutaneous minimally invasive internal fixation with PHILOS inverted:20 males and 10 females with an age of(41.5±11.6)years;type A in 5 cases,type B in 14 cases,and type C in 11 cases by AO fracture classification.In the control group of 35 cases subjected to anterior percutaneous minimally invasive internal fixation with a posterior single plate:23 males and 12 females with an age of(39.9±11.2)years;type A in 7 cases,type B in 17 cases,and type C in 11 cases by AO fracture classification.The preoperative general data,operation time,intraoperative blood loss,total incision length,fracture healing time,and shoulder and elbow VAS scores,Constant-Murley shoulder function score,Mayo elbow performance score(MEPS),and complications at the last follow-up were recorded and compared between the 2 groups.Results There was no significant difference in the preoperative general data between the 2 groups,showing comparability(P>0.05).There were no significant differences either in operation time,fracture healing time,or shoulder or elbow VAS pain score,Constant-Murley shoulder function score,or MEPS at the last follow-up between the 2 groups(P>0.05).The intraoperative blood loss was(59.7±26.6)mL in the observation group and(165.7±86.4)mL in the control group,and the total incision length was(10.7±2.1)cm in the observation group and(18.6±2.7)cm in the control group,showing statistically significant differences between the 2 groups(P<0.01).There was no injury to the radial nerve or musculocutaneous nerves,incision infection or fracture nonunion in the observation group.There were 4 cases of iatrogenic radial nerve injury,2 cases of incision infection and 1 case of fracture nonunion in the control group,yielding a complication rate of 20.0%(7/35).The difference in the incidence of complications was significant between the 2 groups(P<0.01).Conclusion In the treatment of distal humeral shaft fracture with anterior percutaneous minimally invasive internal fixation,PHILOS inverted has advantages of less soft tissue damage,less intraoperative bleeding,and a lower risk of iatrogenic radial nerve injury than the posterior single plate.