前方入路联合MIPO技术治疗肱骨干骨折的有效性和安全性

背景：由于术中广泛剥离、牵拉骨折周围软组织、影响骨折端血供，传统接骨板在治疗肱骨骨折有较高的骨不连发生率和医源性神经损伤发生率。 目的：探讨前方入路联合微创经皮接骨板内固定（MIPO）技术治疗肱骨干骨折的有效性和安全性。 方法：回顾性分析2010年1月至2012年12月收治的77例肱骨干骨折患者的临床资料。根据治疗方法分为MIPO组和对照组。MIPO组采用微创经皮接骨板置入技术进行骨折固定，对照组采用传统的切开复位内固定技术进行骨折固定。对两组患者的手术情况和术后功能恢复进行比较。 结果：两组患者手术顺利，MIPO组手术时间比对照组稍长，住院时间比对照组稍短，但两组间差异无统计学意义（P＞0.05）。MIPO组术中失血量、骨折愈合时间均显著少于对照组（P＜0.05）。末次随访时，MIPO组的肩、肘关节活动度和DASH评分均显著优于对照组（P＜0.05）。两组患者术后均无严重并发症发生。 结论：采用MIPO技术治疗肱骨干骨折具有微创、固定牢靠、并发症少、术后功能恢复迅速且良好等优点，应在肱骨干骨折治疗中推广使用。

Safety and efficacy of minimally invasive plate osteosynthesis for the treatment of humeral shaft fractures through anterior approach

Background：Because of extensive dissection, pulling of surrounding soft tissue of fracture and poor blood supply of broken ends of fractured bone, the incidence of bone nonunion and iatrogenic nerve damage in the treatment of humerus fractures with plate is very high. Objective：To explore the safety and efficacy of minimally invasive plate osteosynthesis （MIPO） for the treatment of humer-al shaft fractures through anterior approach. Methods：Clinical data of 77 patients with humeral shaft fractures treated in our hospital from January 2010 to December 2012 were retrospectively analyzed. Of them, 39 cases were treated with locking proximal humeral plate by MIPO, and 38 cases with common plate by open reduction and internal fixation （ORIF）. The general information and postoperative func-tion recovery were compared between the two methods. Results：The surgical treatments were successfully achieved in all patients. The operative time was longer and hospital stay was shorter in MIPO group as compared with ORIF group, but there was no significant between-group difference （P〉0.05）. The intraoperative blood loss and fracture healing time in MIPO group were significantly less than those in ORIF group （P〈0.05）. At the last follow-up, the range of motion of shoulder and elbow joints and disabilities of the arm, shoulder and hand （DASH） scores in the MIPO group were significantly better than those in the ORIF group （P〈0.05）. No serious complica-tions occurred. Conclusions：Minimally invasive plate osteosynthesis through anterior approach is a recommendable method for acute long oblique humeral shaft fractures with the advantages of microlesion, firm fixation, less complications and good function re-covery.