锁定加压钢板治疗肱骨干粉碎骨折

目的探讨锁定加压钢板治疗肱骨干粉碎骨折的方法及疗效。方法自2005年2月至2006年10月,使用锁定加压钢板治疗肱骨干粉碎骨折37例。结果所有患者获得平均17.3个月（12-26个月）的随访,骨折全部愈合,愈合时间平均10.2周（9-15周）。末次随访根据Neer评分标准评定肩关节功能,优21例,良13例,可3例,优良率达91.89%;以Jupiter肘关节评分系统评价肘关节功能,优18例,良15例,可4例,优良率达89.19%。无继发骨折移位及内固定物失效或断裂。3例术后出现一过性桡神经麻痹,3个月后症状完全消退。结论锁定加压钢板治疗肱骨干粉碎骨折可以提供坚强的固定,有助于早期功能锻炼,是治疗肱骨干粉碎骨折较为理想的内固定物。     

锁定加压钢板微创固定治疗肱骨干骨折的疗效分析

目的探讨锁定加压钢板（10cking compression plate,LCP）经肱骨前外侧入路微创同定治疗眩骨干骨折的方法及疗效。方法2004年2月至2008年5月,采用切开复位LCP固定治疗肱骨干骨折36例,男26例,女10例;年龄18～45岁（平均32岁）,其中25例为机器挤压伤,6例摔伤,5例车祸伤;骨折类型：双段骨折2例,长斜形骨折5例,长段粉碎性骨折6例,伴有碟形骨折块8例,横行和短斜形骨折15例。其中骨折块卡压桡神经1例,其余均未发生神经血管损伤。均于伤后6～48h手术,均为闭合性骨折。结果经18-36个月（平均21个月）随访,36例患者全部愈合,骨折愈合时间为9～16周（平均12．4周）,3例术后出现一过性桡神经麻痹,3个月后症状完全消退,无继发骨折移位及内固定物失效或断裂。肩关节功能按Neer评分,优33例,良2例,可1例;Mayo肘关节评分优34例,良2例。结论经肱骨前外侧入路切开复位LCP固定治疗肱骨于骨折可以提供稳定的周定,软组织损伤小,骨折愈合率较高,神经血管结构相对安全,是治疗肱骨干骨折的良好选择。     

锁定加压钢板固定治疗肱骨干骨折

2005年3月-2006年6月,我科收治13例肱骨干骨折患者,采用锁定加压钢板（LCP）固定治疗,取得了良好的临床疗效。 1材料与方法 1．1病例资料本组13例,男9例,女4例,年龄23～64岁。左侧5例,右侧8例。骨折按AO分型：12-A1型2例,12—A2型1例,12-B1型2例,12-B2型1例,12-B3型4例,12-C1型2例,12-C3型1例。     

微创技术结合锁定加压钢板治疗肱骨干粉碎骨折疗效分析

肱骨干骨折是较常见的骨折,占所有骨折的3％-5％,笔者自2010—03—2011—09采用微创技术结合锁定加压钢板治疗肱骨干粉碎骨折14例,取得满意疗效,报告如下。     

锁定加压钢板微创固定治疗复杂肱骨干骨折

目的探讨肱骨前方入路下结合锁定加压钢板(locking compression plate,LCP)微创治疗复杂肱骨干骨折的初步效果。方法2005年3月～2006年2月于肱骨前方入路下行LCP微创治疗11例复杂肱骨干骨折,并对患者进行回顾性分析。男6例,女5例;年龄32～66岁。其中6例摔伤,5例车祸伤。骨折类型:多段骨折2例,长斜形骨折1例,长段粉碎性骨折8例。骨折线累及干骺端8例,其中骨折块卡压桡神经1例,其余均未发生神经血管损伤。骨折位于肱骨中上段6例,肱骨中下段5例。伤后48h～4d手术,均无开放性骨折。结果11例骨折均于术后2～4个月愈合,1例术前桡神经卡压功能障碍者,经神经探查松解,复位固定,3d后功能恢复。术后均随访6～12个月,患者功能恢复皆良好。肩关节功能按Neer评分优7例,良3例,中1例;HSS评分优9例,良2例。结论肱骨前方入路下结合LCP的微创术是一种治疗复杂性肱骨干骨折安全有效的方法。     

闭合复位经皮锁定加压钢板内固定治疗尺骨骨折

目的：探讨闭合复位经皮锁定加压钢板（locking compression plate, LCP）内固定治疗尺骨骨折方法及疗效。方法2008年5月—2011年6月,使用LCP经尺骨尺背侧入路微创技术治疗尺骨干骨折27例。结果术后经13～32个月（平均16个月）随访,27例骨折全部愈合,骨折愈合时间9--15周（平均12周）,无一例感染及内固定失效（断裂、松动、弯曲）发生,无神经损伤的发生。根据Anderson等前臂骨折功能评价标准评定：优17例,良10例。最终随访术后肘关节伸屈活动功能丧失0°～18°,平均5°;前臂旋前功能丧失0°～29°,平均15°;前臂旋后功能丧失0°～32°,平均16°。结论 LCP经尺骨尺背侧入路微创技术治疗尺骨干骨折可以提供稳定的固定,骨折愈合率高,神经血管结构相对安全,更适合于粉碎性或伴有骨质疏松的骨折。     

经皮微创锁定加压钢板内固定治疗胫骨骨折

目的总结经皮微创锁定加压钢板(locking compressionplate,LCP)内固定术治疗胫骨骨折的方法和临床疗效。方法2005年9月-2007年9月,采用间接复位经皮微创LCP内固定技术治疗胫骨骨折13例。男8例,女5例;年龄18～35岁,平均27岁。致伤原因:车祸伤3例,摔伤5例,高处坠落伤4例,砸伤1例。骨折部位:胫骨上1/3骨折2例,中1/3骨折6例,下1/3骨折5例。均为闭合骨折。骨折按AO分型:A型4例,B型7例,C型2例。伤后至手术时间3h～5d,平均2.5d。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间10～18个月,平均13个月。术后骨折均达临床愈合,愈合时间为12～20周,平均16周。无内固定失败及松动,无旋转及短缩畸形等并发症发生。患肢膝关节功能按HSS评分为85～95分,平均90分;关节活动度为100～130°,平均120°;患肢踝关节功能按美国足踝外科学会制定的踝与后足功能评分标准评分为80～95分,平均92.4分;优9例,良4例,优良率100%。结论经皮微创LCP内固定治疗胫骨骨折符合生物学固定原则,有利于胫骨骨折的愈合及骨折端软组织的修复。     

锁定加压钢板内固定治疗肱骨近端骨折

目的探讨锁定加压钢板治疗肱骨近端骨折的疗效。方法回顾分析2002年2月-2007年7月应用锁定加压钢板内固定治疗肱骨近端骨折39例。结果本组病人39例都得到随访,随访时间平均9个月,优良率87．2％。结论锁定加压钢板内固定是治疗肱骨近端骨折较理想的一种手术方法。     

Minimally invasive locking plate osteosynthesis for fractures of the distal tibia--results in 20 patients

AIMS: We report our experiences with minimally invasive locking plate osteosynthesis (MILPO), for distal tibia fractures, with specific reference to fracture union and complications encountered. PATIENTS AND METHODS: Twenty patients underwent MILPO for open and closed distal tibia fractures between March 2003 and December 2004. Fractures were classified according to the AO system. Open fractures were graded using the Gustilo and Anderson classification and closed fractures via the Tscherne classification system. RESULTS: There were 16 males and 4 females of mean age 44.7 years (range 19-69 years). Thirteen patients had temporary external fixation, prior to definitive fracture fixation. Minimum follow-up was 12 months and average time to full weight bearing in the closed fracture group (12 patients) was 18.1 weeks (range 8-32 weeks) and 19.3 weeks in the open fracture group (8 patients, range 8-44 weeks). Fracture healing was defined as radiological evidence of bridging mature callus combined with pain-free full weight bearing. In the open fracture group, four fractures united within 6 months, one within 6-12 months and one united 12 months after surgery; there were two cases of non-union. In the closed fracture group, seven fractures united within 6 months, three fractures between 6 and 12 months and two after 12 months from surgery. Two of the 20 patients required additional procedures to aid bone healing in the post-operative period. Three of the 20 patients required metalwork removal, for delayed wound breakdown in two cases and wound infection in one case. An uneventful recovery was made following this, in all three cases. There was one case of implant failure due to plate breakage at 32 weeks post-op. The fracture site was opened and re-plated at 32 weeks with a DCP. There were no complications following this. CONCLUSION: MILPO was used for definitive fixation of high energy, open and closed, peri-articular distal tibia fractures. This approach aims to preserve bone biology and minimise surgical soft tissue trauma. This surgical approach may provide an answer to treating a challenging group of fractures and further research is warranted.     

前侧微创入路锁定加压钢板内固定治疗肱骨中下段骨折

目的观察前侧微创入路(MIPO)锁定加压钢板(LCP)内固定治疗肱骨中下段骨折的临床疗效。方法回顾性分析自2012-01—2014-10采用前侧入路MIPO技术LCP内固定治疗的14例闭合性肱骨中下段骨折。术后观察桡神经功能、骨折愈合时间、肩肘关节功能。结果本组手术时间65~115 min,平均89 min。术后切口均一期愈合,无医源性桡神经损伤。14例均获得随访10~21个月,平均14个月。1例出现肌皮神经支配区域皮肤感觉减退,术后3个月自行恢复。骨折愈合时间10~15周,平均13周。末次随访时肩关节功能Neer评分:优12例,良2例;肘关节功能Mayo评分:优13例,良1例。结论前侧入路MIPO技术LCP内固定治疗肱骨中下段骨折具有创伤小、神经损伤风险低等优点。     

Danger zone for locking screw placement in minimally invasive plate osteosynthesis (MIPO) of humeral shaft fractures: A cadaveric study

Several recent reports have described the minimally invasive plate osteosynthesis (MIPO) technique in the treatment of humeral shaft fractures by the anterior approach. The purpose of this study is to identify the danger zone for locking screw placement to avoid musculocutaneous nerve injury in the anterior compartment and radial nerve injury in the posterior compartment of the humerus relative to the humeral length. Eighteen arms of fresh cadavers were fixed with 10-hole locking compression plate (LCP) by anterior approach using the MIPO technique. Two locking screws on each end were fixed by the open technique; the rest of the screws were inserted percutaneously. The arms were dissected both anterior and posterior to identify musculocutaneous and radial nerve injuries. Humeral length with a simple palpable bony landmark was measured from the posterior tip of the acromion process to the lateral epicondyle. Damage or direct contact of the locking screws to the musculocutaneous or radial nerve was recorded, and the distance between the screws and the radial nerve was measured.The average humeral length was 29.71 cm (99% confidence interval (CI): 28.54-30.86 cm). The danger zone for the musculocutaneous nerve averaged 18.37% (99% CI: 17.06-19.60) to 42.67% (99% CI: 42.33-43.03) of the humeral length from the lateral epicondyle. The danger zone for the radial nerve averaged 36.35% (99% CI: 35.81-37.07) to 59.20% (99% CI: 59.00-59.46) of the humeral length, and the most dangerous screws that penetrated or touched the radial nerve lay 47.22% (99% CI: 45.27-49.17) to 53.21% (99% CI: 51.16-55.33) of the humeral length from the lateral epicondyle. An anteroposterior locking screw placed percutaneously endangered the musculocutaneous and radial nerves.From this cadaveric study, the danger zone for the musculocutaneous and radial nerves could be determined as a percentage of the humeral length. Since the zone with radial nerve injuries shows a large variation, this procedure should only be done by experienced surgeons.     

前侧入路MIPO技术LCP内固定治疗肱骨干中下段骨折

目的探讨采用前侧入路微创钢板接骨术(MIPO)结合锁定加压钢板(LCP)内固定治疗肱骨干中下段骨折的安全性与疗效。方法回顾性分析自2012-01—2014-06采用前侧入路MIPO技术结合锁定加压钢板(LCP)内固定治疗肱骨干中下段骨折16例。末次随访时按Constant-Murley肩关节评分系统评定肩关节功能,按改良Mayo肘关节功能评分系统评定肘关节功能。结果本组手术时间75~110 min,平均92 min;术中出血量50~150 ml,平均75 ml。16例均获得随访,随访时间6~24个月,平均12.3个月。骨折均于术后3~4个月临床愈合,平均3.4个月。所有患者骨折均愈合,无内固定失败、医源性桡神经和肌皮神经损伤。末次随访时Constant-Murley肩关节评分平均95.3分,改良Mayo肘关节功能评分平均93.3分,16例功能评价均达优。结论采用前侧入路MIPO技术结合LCP内固定治疗肱骨干中下段骨折具有固定可靠、创伤小、保护血供、神经安全、骨折愈合率高、并发症少、功能恢复佳等优点,完全符合骨折治疗理念中的生物学固定原则,可成为治疗肱骨干中下段骨折较理想的手术方法。     

锁定加压钢板微创治疗肱骨干骨折（钢板内固定）术后失效11例

目的：探讨锁定加压钢板（locking compression plate, LCP）微创治疗肱骨干骨折钢板内固定术后失效的临床效果。方法2009年4月-2011年1月收治肱骨干骨折术后内固定失效患者11例,均采用LCP置入,原内固定物取出,骨折端有缺损者行自体骨植骨。结果11例术后获12～25个月（平均17个月）随访,骨折全部愈合,愈合时间3～7个月（平均4.5个月）。肘关节功能按Mayo评分标准评定：优7例,良3例,可1例,优良率90.9%。肩关节功能按Neer评分标准评定：优7例,良4例,优良率100%。无钢板螺钉松动、弯曲及断裂等内固定失效的发生,无神经、血管损伤。结论对于肱骨干骨折钢板内固定术后失效的患者,采用LCP微创治疗,必要时一期植骨,具有骨折愈合率高、功能恢复好等优点。     

Minimally invasive plate osteosynthesis with locking compression plate in patients with Vancouver type B1 periprosthetic femoral fractures

BackgroundPeriprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) remain one of the most challenging complications to address. Although the principal treatment modalities for Vancouver type B1 fractures are open reduction and internal fixation (ORIF), surgeons have not yet reached a consensus on the optimal method for reduction and fixation. We therefore investigated whether minimally invasive plate osteosynthesis (MIPO) using locking compression plate (LCP) would lead to favorable outcomes for patients with Vancouver type B1 PFFs. In addition, we also compared the outcomes of patients treated with MIPO to those treated with ORIF.MethodWe retrospectively evaluated the clinical and radiographic outcomes of a series of 21 Vancouver type B1 PFFs treated with MIPO and LCP between February 2011 and February 2017. The mean duration of follow-up was 33.8 months. We also compared outcomes of these patients to those of patients with 19 Vancouver type B1 fractures treated with ORIF between April 2006 and December 2011.ResultsFracture healing without complications was achieved in 20 (95.2%) out of 21 cases in the MIPO group and in 14 (87.5%) out of 16 cases in the ORIF group. There was one case of fixation failure with stem subsidence in the MIPO group. In the ORIF group, there were 2 nonunion with metal failure. Operation time was significantly shorter and intraoperative blood loss was significantly less in the MIPO group compared to the ORIF group. However, there were no significant differences in frequency of transfusion, time-to-union, walking abilities, modified Harris hip score, or complications.ConclusionThe radiological and clinical outcomes of MIPO using LCP in patients with Vancouver type B1 PFFs were shown not to be inferior to ORIF and resulted in fewer intraoperative complications than ORIF. If care is taken regarding the stability of femoral implant and optimal surgical techniques, MIPO may be a recommended option in the treatment of Vancouver type B1 periprosthetic fracture.     

LC-DCP与LCP内固定治疗肱骨干骨折的疗效比较与适应证分析

目的比较有限接触动力加压钢板(LC-DCP)与锁定加压钢板(LCP)内固定治疗肱骨干骨折的临床效果并分析其手术适应证。方法回顾性分析自2010-05—2014-10采用LC-DCP与LCP内固定治疗的156例肱骨干骨折,其中LC-DCP组64例,LCP组92例。比较2组手术时间、术中出血量、住院时间、骨折愈合时间、肩肘关节活动度及术后并发症,末次随访时采用UCLA肩关节功能评分和Mayo肘关节功能评分评定疗效。结果所有患者均获得平均18(12~28)个月随访。LCP组术中出血量少于LC-DP组,骨折愈合时间短于LC-DCP组,差异有统计学意义(P0.05)。2组手术时间、住院时间、肩肘关节活动度、UCLA及Mayo评分比较差异无统计学意义(P0.05)。LCP组内固定失效率明显低于LC-DCP组,差异有统计学意义(P=0.0330.05);但2组医源性桡神经损伤及感染发生率比较差异无统计学意义(P0.05)。结论 LC-DCP和LCP均是切开复位内固定治疗肱骨干骨折的有效固定材料,相比于LC-DCP,LCP内固定具有骨折愈合时间短、内固定失败率低及适应证广的优点。     

锁定加压接骨板微创固定治疗肱骨二或三部分骨折的初步报告

目的 探讨肱骨前方入路结合锁定加压接骨板微创治疗肱骨二或三部分骨折的疗效. 方法 2005年3月至2008年10月,经肱骨前方入路应用锁定加压钢板(LCP)或肱骨近端内固定系统(PHILOS)钢板微创治疗22例肱骨二或三部分骨折患者,男13例,女9例;年龄46～78岁,平均63.4岁);左侧7例,右侧14例.骨折类型:肱骨干骨折伴肱骨近端骨折11例,肱骨干骨折伴肱骨远端骨折8例,肱骨干骨折伴肱骨近端骨折及肩关节脱位2例,肱骨干骨折合并肱骨近端、远端骨折及肩关节脱位1例.其中2例术前伴桡神经损伤,急诊行桡神经探查后再复位固定骨折.记录手术时间及术中出血量.采用Neer肩关节评分标准及肘关节HSS评分标准分别对患者患侧肩关节和肘关节进行评分.结果 评价以1年为标准,其中1例患者术后随访不到1年,以随访终末时间为结点. 结果 22例患者的手术时间78～150 min,平均107.9 min;术中出血量110～450 mL,平均274 mL.20例术后获平均9.4个月(8～22个月)随访,2例失访.20例患者骨折均获愈合,愈合时间8～16周(平均11.5周).骨折端无移位,螺钉无松动、拔出及断钉发生.2例术前伴桡神经损伤患者,1例3 d后功能恢复,另1例4个月后功能恢复.肩关节功能按Neer评分标准评定:优12例,良5例,中3例,优良率为85.0%.肘关节功能按HSS评分标准评定:优16例,良4例,优良率100%. 结论 肱骨前方切口经皮置入锁定加压接骨板具有创伤小、不损伤腋神经及桡神经等优点,治疗肱骨二或三部分骨折可获得较理想的临床疗效.     

经皮微创锁定钢板内固定治疗胫骨干骨折

目的探讨经皮微创锁定钢板内固定技术（MIPPO）治疗胫骨干骨折的疗效。方法回顾性分析自2010-01—2013-03采用MIPPO技术治疗胫骨干骨折38例（MIPPO组）,与同时期切开复位内固定治疗的30例胫骨干骨折（切开复位组）进行比较,观察2组切口长度、手术时间、术中出血量、住院时间、骨折愈合时间、并发症发生率及术后12个月Johner-Wruhs评分。结果 68例均获得平均18.3（12-24）个月随访。MIPPO组在切口长度、手术时间、术中出血量、住院时间、骨折愈合时间方面优于切开复位组,差异有统计学意义（P〈0.05）;而2组术后并发症发生率和术后12个月Johner-Wruhs评分优良率差异无统计学意义（P〉0.05）。结论 MIPPO技术治疗胫骨干骨折符合生物固定原理,较传统切开复位内固定术具有一定优势,是治疗胫骨干骨折有效的方法。     

前侧入路MIPPO技术与髓内钉内固定治疗肱骨干骨折的疗效比较

目的比较前侧入路微创经皮钢板内固定技术(MIPPO)与髓内钉内固定治疗肱骨干骨折的临床效果。方法回顾性分析自2009-05—2013-08分别采用MIPPO技术、顺行髓内钉内固定与逆行髓内钉内固定治疗的肱骨干骨折54例,MIPPO组21例,顺行髓内钉组18例,逆行髓内钉组15例。比较3组手术时间、术中出血量、骨折愈合情况、功能恢复情况、术后并发症。结果 3组术中出血量(F=72.040,P0.001)、骨折愈合时间(F=9.351,P0.001)比较差异无统计学意义,但MIPPO组手术时间较顺行髓内钉组和逆行髓内钉组短,差异有统计学意义(F=84.783,P=0.058)。54例均获得平均18.9(11~39)个月随访。MIPPO组疗效优良率明显高于顺行髓内钉组和逆行髓内钉组,并发症发生率明显低于顺行髓内钉组和逆行髓内钉组,差异有统计学意义(P0.05)。结论采用前侧入路MIPPO技术治疗肱骨干骨折避免了传统切开复位钢板内固定的缺点,也避免了髓内钉内固定术后的并发症,而且操作简单,学习曲线较短。