经前方入路微创锁定加压接骨板内固定治疗肱骨中下段螺旋形骨折

目的探讨锁定加压接骨板(LCP)经前方入路微创内固定技术(MIPO)治疗肱骨中下段螺旋形骨折的临床疗效。方法回顾分析2016年12月至2018年1月厦门大学附属成功医院骨科采用LCP经前方入路MIPO治疗的12例闭合性肱骨中下段螺旋形骨折患者资料。男8例,女4例;年龄18~38岁,平均21.8岁。按AO/OTA骨折分型:12-A1.2型5例,12-A1.3型2例,12-B1.2型2例,12-B1.3型2例,12-C1.1型1例。记录患者手术时间、术中出血量、术后早期并发症、骨折愈合时间;末次随访时采用美国加州大学洛杉矶分校(UCLA)肩关节评分标准评定肩关节功能,采用Mayo肘关节功能评分系统(MEPS)评定肘关节功能。结果手术时间为43~130 min,平均63 min;术中出血量为60~280 mL,平均139 mL。术后切口均一期愈合,未出现感染及医源性神经损伤等并发症。12例患者术后获10~21个月(平均13.7个月)随访。所有患者均获骨性愈合,愈合时间11~20周,平均15.8周。术后均未发生内固定物松动、断裂。末次随访时肩关节功能UCLA评分为31~35分,平均34.5分;肘关节功能MEPs评分为90~100分,平均99分。结论采用LCP经前方入路MIPO治疗肱骨中下段螺旋形骨折具有创伤小、神经损伤风险低、临床疗效满意的优点,是一种安全有效的肱骨微创内固定技术,值得临床推广。

Anterior minimally invasive osteosynthesis using a locking compression plate for spiral fractures of mid-distal humeral shaft

Objective To evaluate the effectiveness of anterior minimally invasive osteosynthesis using a locking compression plate for spiral fractures of the mid-distal humeral shaft.Methods A retrospective analysis was made of the clinical data of 12 patients who had undergone anterior minimally invasive osteosynthesis using a locking compression plate for spiral fractures of the mid-distal humeral shaft between December 2016 and January 2018.They were 8 males and 4 females,aged from 18 to 38 years(mean,21.8 years).According to the AO/OTA classification,5 cases were defined as type 12-A1.2,2 as type 12-A1.3,2 as type 12-B1.2,2 as type 12-B1.3 and one as type 12-C1.1.The operation time,intraoperative blood loss,early postoperative complications and union time were recorded;the functional recovery of the elbow joint was evaluated by the Mayo elbow performance score(MEPS)and that of the shoulder by the University of California at Los Angeles(UCLA)shoulder rating scale at the final follow-up.Results The mean operation time was 63 minutes(range,from 43 to 130 minutes),and the mean intraoperative blood loss 139 mL(range,from 60 to 280 mL).All incisions healed by the first intention without any neurologic complications or wound infection.All the 12 patients were followed up for 10 to 21 months(mean,13.7 months).Bony union was obtained in all cases after 11 to 20 weeks(mean,15.8 weeks).No loosening or breakage of internal fixation occurred.At the final follow-up,the MEPS ranged from 90 to 100(mean,99)and the UCLA shoulder scores from 31 to 35(mean,34.5).Conclusion Anterior minimally invasive osteosynthesis using a locking compression plate is safe and feasible for spiral fractures of the mid-distal humeral shaft,leading to minimal invasion,a low risk for iatrogenic nerve injury and satisfactory effectiveness.