上臂前外侧入路双锁定钢板治疗肱骨干骨折骨不连13例临床分析

目的探讨上臂前外侧入路双锁定钢板治疗肱骨干术后骨不连的临床疗效。方法回顾2015年2月至2018年6月在我科行上臂前外侧入路双钢板治疗肱骨干骨折术后骨不连患者并随访获得完整资料的患者13例。其中,男8例,女5例;左侧4例,右侧9例;年龄21~75岁,平均50.2岁;肱骨干上1/3段骨折3例,中1/3段骨折8例,下1/3段骨折2例;10例患者钢板断裂失效,3例钢板完好。增生性骨不连9例,缺血性骨不连3例,萎缩性骨不连1例。记录患者基本信息和随访结果,肩关节Constant-Murley评分、肘关节Mayo评分、患侧上肢DASH评分来评定临床疗效。结果 13例患者随访获得完整随访资料,平均随访10.7个月(9~14个月),所有患者均获得骨性愈合,平均愈合时间6.2个月(4~11个月),1例出现术后一过性桡神经麻痹,该患者术后2个月恢复正常,并发症发生率为7.69%。患者肩关节Constant-Murley评分(术前67.2±5.7、术后末次随访81.2±4.4),肘关节Mayo评分(术前74.2±5.4、术后末次随访80.2±3.2),患侧上肢DASH评分(术前8.9±2.7、术后末次随访7.97±2.3)。该三项评分术后末次随访较术前改善,与术前比较差异有统计学意义(P<0.05)。结论上臂前外侧双锁定钢板治疗肱骨干骨折骨不连效果满意。

Clinical efficacy of 13 cases of nonunion of humeral shaft fracture treated by anterolateral approach of upper arm and double locking plate

Objective To explore the clinical efficacy of anterolateral approach of upper arm and double locking plate fixation in the treatment of nonunion of humeral shaft fracture. Methods The data of 13 patients with nonunion of humeral shaft fracture treated by anterolateral approach of upper arm and double plate in our department from February 2015 to June 2018 were reviewed, including 8 males and 5 females. There were 4 cases on the left and 9 cases on the right.The patients ranged from 21 to 75 years old, with an average age of 50.2 years old. There were 3 cases of upper 1/3 fracture of humeral shaft, 8 cases of middle 1/3 fracture and 2 cases of lower 1/3 fracture.10 patientshad the steel plates broken and failed, while 3 were intact. .There were 9 cases of proliferative nonunion, 3 cases of ischemic nonunion, and 1 case of atrophic nonunion. The basic information and follow-up results were recorded. Constant-Murley score of shoulder joint, Mayo score of elbow joint and DASH score of affected upper limb were used to evaluate clinical efficacy. Results All the 13 patients were followed up for an average of 10.7 months (from 9 to 14 months). All the patients were healed with an average of 6.2 months (from 4 to 11 months). One case presented with transient radial nerve palsy, and the patient returned to normal 2 months after surgery, with a complication rate of 7.69%.Constant-murley score of shoulder joint (67.2±5.7 preoperative, 81.2±4.4 the last follow-up), Mayo score of elbow joint (74.2±5.4 preoperative, 80.2±3.2 the last follow-up), DASH score of upper limb (8.9±2.7 preoperative, 7.97±2.3 the last follow-up) were all significantly improved. Compared with preoperative results, there was statistical significance (P<0.05). Conclusion The anterolateral approach of upper arm and double locking plate fixation is effective in the treatment nonunion of humeral shaft fracture.