摘要
目的比较传统切开复位钢板内固定(open reduction and platingoste osynthesis,ORPO)和闭合复位微创钢板内固定(minimal invasive platingoste osynthesis,MIPO)治疗肱骨干中下段骨折的临床效果。方法2004年3月-2006年10月,分别采用MIPO和ORPO技术治疗40例肱骨干中、下段闭合骨折患者。MIPO组19例,男14例,女5例;年龄19～60岁,平均39.05岁。肱骨干中段骨折10例,下段骨折9例。根据OTA分型:A型3例,B型13例,C型3例。合并桡神经麻痹4例。ORPO组21例,男13例,女8例;年龄24～62岁,平均39.05岁。肱骨干中段骨折13例,下段骨折8例。根据OTA分型:A型14例,B型7例。合并桡神经麻痹5例。两组受伤至手术时间2～14d。MIPO组行闭合复位,经上臂前侧远离骨折部位小切口肌下插入钢板,置肱骨干前侧固定,不显露桡神经。ORPO组经上臂前外侧或后侧入路,显露桡神经并加以保护,后显露骨折端并复位,钢板置肱骨干前外或后侧固定。采用肩关节UCLA评分及肘关节Mayo评分标准评价疗效。结果术后患者切口均Ⅰ期愈合。MIPO组无医源性桡神经麻痹患者出现;ORPO组有5例出现一过性桡神经麻痹,至最后一次随访时桡神经功能全部恢复。MIPO组18例获随访,随访时间14～44个月,平均25.44个月;ORPO组19例获随访,随访时间13～48个月,平均32.11个月。骨折愈合时间MIPO组12～32周,平均17.06周;ORPO组8～58周,平均16.11周;比较差异无统计学意义(P>0.05)。两组患者均无骨不连、内固定断裂发生。肩关节前屈活动度:MIPO组150～170°,平均166.94°;ORPO组130～170°,平均164.74°。肩关节UCLA评分:MIPO组33～35分,平均34.78分;ORPO组30～35分,平均34.42分。肘关节活动度:MIPO组120～140°,平均133.33°;ORPO组120～140°,平均136.7°。肘关节Mayo评分:MIPO组90～100分,平均99.44分;ORPO组95～100分,平均99.74分。以上各指标两组比较差异均无统计学意义(P>0.05)。结论ORPO与MIPO技术治疗肱骨干中下段骨折均可获得良好效果,但MIPO技术具有无需显露桡神经、不会造成医源性桡神经麻痹的优点。
Objective To compare the clinical results of two plating osteosynthesis techniques, open reduction and plating ostosynthesis （ORPO） and minimal invasive plating osteosynthesis （MIPO）, in surgical treatment of mid-distal humeral shaft fractures. Methods From March 2004 to October 2006, 40 cases of closed unilateral mid-distal humeral shaft fractures were surgically treated with MIPO or ORPO. In the MIPO treated group （n=19）, there were 14 males and 5 females, with a mean age of 39.05 years. Fractures involved in middle humeral shaft in 10 cases and distal fragment in 9 cases. According to OTA classification, there were 3 cases of type A, 13 cases of type B and 3 cases of type C. Four cases complicated by radial nerve palsies. In the ORPO treated group （n=21）, there were 13 males and 8 females with a mean age of 39.05 years, including 14 cases of type A and 7 cases of type B fractures according to OTA classification. The fractures involved in middle humeral shaft in 13 cases and distal fragment in 8 cases. Five cases complicated by radial nerve palsies. The time from injury to operation in both groups were 2 to 14 days. For patients in the MIPO group, fractures were closely reduced and fixated with an anterior placed plate inserted through two small incisions made at the anterior side of arm, away from fracture sites. The radial nerves were not exposed. For patients in the ORPO group, fractures were exposed, reduced, and fixated with an anterolateral or a posterior positioned plate after careful dissection and protection of radial nerve through an anterolateral or a posterior approach. The operation time, the occurrence of iatrogenic radial nerve palsy and the bone healing time were recorded. The functions of the affected shoulders and elbows were evaluated with UCLA end-result score and Mayo elbow perform index （MEPI）, respectively. Results All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in the MIPO group after surgery; however, 5 cases of transient iatrogenic radial nerve palsies were identified in the ORPO group after surgery, and the function of radial nerve recovered in these cases at the last follow-up. Eighteen cases were followed up 14-44 months （mean 25.44 months） in MIPO group, and 19 cases were followed up 13-48 months （mean 32.11 months） in ORPO group. The mean bone healing time was 17.06 （12-32） weeks in MIPO group and 16.11 （8-58） weeks in ORPO group, showing no significant difference between two groups （P 〉 0.05）. There was no nonunion and hardware failure in both groups. The mean forward flexion of the shoulder was 166.94° （150-170°） in MIPO group and 164.74° （130-170°） in ORPO group. The mean UCLA shoulder score was 34.78 （33-35） points in MIPO group and 34.42 （30-35） points in ORPO group. The mean range of motion of the elbow in MIPO and ORPO groups was 133.33° （120-140°） and 136.7° （120-140°）, respectively. The MEPI in these two groups was 99.44 （90-100） and 99.74 （95-100） points, respectively. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion The good results could be obtained when ORPO and MIPO technique are applied to treat mid-distal humeral shaft fractures. MIPO technique has advantages to not expose the radial nerve and to decrease the occurrence of iatrogenic radial nerve palsies.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第1期41-44,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肱骨干骨折
钢板固定
切开复位
闭合复位
微创技术
临床比较
Humeral shaft fracture Plating osteosynthesis Open reduction Closed reduction Minimal invasive technique Clinical comparison
