外固定架辅助下微创经皮钢板内固定治疗肱骨干骨折

目的探讨外固定架辅助下微创经皮钢板内固定(MIPPO)技术锁定钢板前置内固定治疗肱骨干骨折的临床疗效。方法对32例肱骨干骨折患者采用外固定架临时复位固定下MIPPO技术锁定钢板前置内固定治疗。结果术中出血量50~100 ml,手术时间50~120 min。患者均获得随访,时间6~12个月。术后X线片显示解剖复位7例,功能复位25例。无感染、骨不连、桡神经损伤等并发症。末次随访时,肩关节功能Neer评分:优27例,良3例,差2例;肘关节功能Mayo评分:优25例,良4例,差3例;肩关节活动度:上举145°~180°30例、90°~144°2例,前屈45°~90°32例,后伸20°~40°27例、0°~19°5例,内收20°~40°31例、0°~19°1例,外旋45°~60°26例、0°~44°6例,内旋45°~70°29例、0°~44°3例;肘关节活动度:屈135°~150°29例、90°~134°3例,伸5°~10°25例、0°~4°7例。结论外固定架临时固定下,采用MIPPO技术锁定钢板前置内固定治疗肱骨干骨折,具有创伤小、复位满意、骨折愈合快、术后肩关节功能良好和并发症少等优点。

Treatment of humeral shaft fracture with minimally invasive percutaneous plate osteosynthesis assisted by external fixator

Objective To investigate the clinical effect of minimally invasive percutaneous plate osteosynthesis(MIPPO)assisted with external fixator in the treatment of humeral shaft fractures.Methods The 32 cases of humeral shaft fracture were treated by MIPPO technique locking plate anterior internal fixation under temporary reduction with external fixator.Results The bleeding volume was 50~100 ml and the operation time was 50~120 min.All patients were followed up for 6~12 months.Postoperative X-ray film showed anatomical reduction in 7 cases and functional reduction in 25 cases.There were no complications such as infection,nonunion and radial nerve injury.At the last follow-up,Neer score of shoulder joint function was excellent in 27 cases,good in 3 cases and poor in 2 cases;Mayo score of elbow joint function was excellent in 25 cases,good in 4 cases and poor in 3 cases.The range of motion of shoulder joints were upper lift with 145°~180°in 30 cases,90°~144°2 cases;anterior flexion with 45°~90°32 cases;posterior extension with 20°~40°27 cases,0°~19°5 cases;adduction with 20°~40°in 31 cases,0°~19°1 case,external rotation with 45°~60°26 cases,0°~44°6 cases;internal rotation with 45°~70°in 29 cases,0°~44°in 3 cases.The range of motion of elbow joints were flexion with 135°~150°in 29 cases,90°~134°in 3 cases;and 25 cases of flexion with 5°~10°,7 cases of flexion with 0°~4°.Conclusions MIPPO technique locking plate anterior internal fixation for humeral shaft fracture under temporary external fixator have the advantages of less trauma,satisfactory reduction,rapid fracture healing,good shoulder function and fewer complications.