微创旋入钉内固定技术治疗伴桡神经麻痹的肱骨干中下段骨折

目的：总结微创旋入钉内固定技术在治疗伴桡神经麻痹的肱骨干中、下段骨折的应用效果。方法：自2004年1月至2008年1月，收治36倒伴桡神经麻痹的肱骨干中、下段骨折患者。其中男28例，女8例；年龄20～58岁，平均36．5岁。致伤原因：机械伤18例，交通伤8例，意外伤10例，均为闭合性骨折。根据AO分型：A1型5例，A2型7例，B1型8例，B2型7例，B3型5例，C3型4例。于骨折部位外侧做小切口，探查桡神经后，复位骨折。经肩峰外侧做小切口，分开三角肌，于大结节后侧开槽，顺行用髓腔钻扩髓，挑选合适旋入钉旋入髓腔远端，沿槽口打入锁片完成固定。记录术后并发症、骨折愈合时间、桡神经功能恢复时间、肩关节和肘关节屈伸范围。采用ASES肩关节和HSS肘关节评分标准评价疗效.结果：36例患者切口均Ⅰ期愈合。获随访9-36周，平均18．5周。骨折愈合时间12～16周，平均为15．6周。桡神经功能术后12～36周完全恢复，平均17．8周。肩关节外展150°～170°，平均160°；肘关节活动范围130°～140°，平均135°。肩关节功能根据ASES评分标准，由术前的（43．85±8．90）分上升至术后的（91．27±7．66）分，差异有统计学意义（t=24．238，P=0．000），其中优20例，良12例，可4例；肘关节根据HSS评分标准，由术前的（39．97±16．06）分上升至术后的（96．22±3．59）分，差异有统计学意义（t=20．512，P=0．000），36例均为优。结论：采用微创旋入钉内固定技术治疗伴桡神经麻痹的肱骨干中、下段骨折可获得良好效果。

Treatment of mid-distal humeral shaft fractures associated with radial nerve palsysis by minimally invasive screwed nails osteosynthesis technique

Objective：To investigate the surgical treatment of mid-distal humeral shaft fractures associated with radial nerve palsysis with minimal invasive screwed nails osteosynthesis technique. Methods：Thirty-six patients treated mid-distal humeral shaft fractures associated with radial nerve palsysis from January 2004 to January 2008. There were 28 males and 8 females whose age ranged from 20 to 58 years old with an average of 36.5 years old. Injury reasons：mechanical injury 18 cases, traffic injury 8 cases ,accidents injury 10 cases ,all cases were closed fracture. According to AO/ASIF classification ,type A1 5 cases, type A2 7 cases, type B 1 8 cases,type B2 7 cases,type B3 5 cases, type C3 4 cases. The small lateral incision was performed located to the fracture. After exploration of the radial nerve, the fractures were reduced. By acromion small lateral incision,the deltoid was separated. In the posterior macronodular slotted antegrade reamed bored with medullary cavity drill and selected a suitable screwed nail screwed into the medullary cavity distal. Along the slot,the locking pieces were inserted to complete the fixation. The postoperative complication, fracture healing time, radial nerve function recovery time, the motion of shoulder and elbow were recorded. Results：The incision of all cases healed with stage Ⅰ . The patients were followed up for 9- 36 weeks with an average of 18.5 weeks. The X-ray examination showed fractures healing in 12-16 weeks （average of 15.6 weeks）. Radial nerve function recovered fully at 12-36 weeks after operation （average of 17.8 weeks）. Shoulder abduction is 150°-170° with an average of 160° ;elbow motion of activities was 130°-140° with an average of 135°. The ASES method was used to assess the shoulder joint function,20 cases gained the excellent result, 12 good and 4 poor. And according to HSS method, 36 cases of elbow joint function gained the excellent result. Conclusion：The surgical treatment of mid-distal humeral shaft fractures associated with radi