微创三切口技术治疗累及远端的肱骨中下段骨折

目的 探讨微创三切口双钢板固定技术治疗累及肱骨远端特别是肱骨远端、关节面的肱骨干中下段骨折的疗效.方法 2004年9月至2007年11月共收治6例累及肱骨远端的肱骨干中下段骨折患者,经肘关节内侧切口复位关节内骨折,空心螺钉固定.肱骨远端与骨干复位后,内侧柱用1/3管型钢板固定.肱骨干骨折采用闭合复位,于上臂前侧三角肌和肱二头肌之间另做小切口,制备此小切口与肘关节外侧切口之间的肌下隧道.将塑形的4.5 mm动力加压钢板经上臂小切口肌下插入,至肘关节外侧切口.钢板近端置于肱骨于前缘,远端置于外侧柱前外侧面,各至少3枚螺钉固定.术后采用Mayo肘关节功能评分系统评价结果.结果 6例患者术后获13～36个月(平均22.2个月)随访.骨折均获愈合,愈合时间为12～24周(平均19周).无医源性桡神经麻痹及内固定失败病例发生.肘关节活动度为110°～140°,平均130.8°.根据Mayo肘关节评分标准评定疗效:全部为优.结论 采用微创三切口双钢板技术治疗累及肱骨远端关节面的肱骨中下段骨折操作简单,可获得满意效果.

Minimally invasive three-incision technique for humeral fractures of middle and inferior shaft involving the distal end

Objective To assess the minimally invasive three-incision technique used in surgical treatment of humeral fractures of middle and inferior shaft involving the distal end. Methods Six cases of humeral fractures of middle and inferior shaft involving the distal end were surgically treated from 2004 to 2007. A combined medial and lateral elbow incision was made to expose the intra-articular fracture of distal humerus. The articular fragments were reduced and fixed with a cannulated screw. The articular component was then reduced to the metaphyseal part of the distal humerus and fixed with a medially positioned one-third tubular plate. The humeral shaft fracture was closely reduced. A pre-contoured 4.5 mm dynamic compression plate was inserted through a small incision made at the anterior side of the proximal part of the arm and placed proximally on the anterior aspect of the humeral shaft and distally on the anterolateral side of the lateral column of the distal humerus to fulfill the fixation of both the humeral shaft and the articular component. Bone healing time, range of motion (ROM) of the affected elbow and postoperative complications were recorded. Elbow functions were evaluated by the Mayo system. Results The 6 cases were followed up for a mean time of 22. 2 months (range, 13 to 36 months). All the fractures were healed in a mean time of 19 weeks (range, 12 to 24 weeks) . The mean ROM of the elbow was 130. 8° (range, 110° to 140°) . No iatrogenic radial nerve paralysis or hardware failure occurred in this series. By the Mayo evaluation system, the elbow functions were rated as excellent for all in this series. Conclusion The minimally invasive three-incision technique is simple and effective for treatment of humeral fractures of middle and inferior shaft involving the distal end.