微创经皮钢板固定技术前置锁定加压钢板治疗肱骨中下段骨折

目的评价采用微创经皮钢板固定技术（MIPO）前置锁定加压钢板（LCP）治疗肱骨中下段骨折的疗效。方法 2008年6月至2010年5月采用MIPO技术前方植入4.5mmLCP治疗18例肱骨中下段骨折患者。观察术后骨折愈合时间、肱骨干力线及肱二头肌功能、桡神经功能、肌皮神经功能。结果经随访12～18个月,平均14.5个月,所有患者均获得骨性愈合,愈合时间9～15周,平均11.2周。手臂肩残疾问卷表评分9～42分,平均12分。所有患者患肢力线均良好,无继发移位及内固定物失效、断裂。术后前后位X线片示骨折远近端成角0°10例,外翻成角2°、5°、9°各1例,内翻成角3°、4°、5°、11°、12°各1例。肱二头肌肌力均为5级。1例患者出现前臂外侧皮神经支配区感觉减退,2个月后恢复。无医源性桡神经麻痹患者。结论采用MIPO技术前置LCP治疗肱骨中下段骨折,骨折愈合时间短,神经损伤并发症少,创伤小。

Locking compression plate osteosynthesis with minimally invasive percutaneous for the treatment of middle and distal third humeral fractures

Objective To evaluate the clinical outcomes of humeral fractures of the middle and distal third segment treated with locking compression plate under minimally invasive percutaneous plate osteosynthesis.Methods Eighteen patients with middle or distal third humeral fracture from June 2008 to May 2010 were enrolled in this study.All cases were treated with locking compression plate osteosynthesis under minimally invasive percutaneous.The time of bony union,alignment of humeral shaft,function of biceps brachil,the functional status of radial nerve,musculocutaneous nerve post operation were observed and followed up.Results At the 12-18 months（mean 14.5 months） followed up,bony union was obtained in all patients.Bone healing time was 9-15 weeks（mean 11.2 weeks）.The mean disabilities of the arm,shoulder and hand（DASH） score was 9-42（mean 12）.Ideal alignments of sick arm were obtained in all patients.No secondary displacement and fatigue or fracture of plate were found in this series.Absolute right alignment was obtained in 10 cases.Valgus angulation of 2°,5° and 9° were respectively seen in 1 case,and Varus angulation of 3°,4°,5°,11°and 12°were respectively seen in 1 case.The myodynamia of biceps were grade 5 in all patients.Hypoesthesia of the neurocutaneous territory in the lateral of forearm occurred in one case and recovered after two months.There was no iatrogenic radius nerve injury in this series.Conclusions Minimally invasive percutaneous locked compression plate osteosynthesis has advantages of rapid bone union,less complications of nervous injury and less trauma for treating fractures of middle and distal third humerus.