中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2011年
8期
710-714
,共5页
黄沛彦%董有海%顾军%程根祥
黃沛彥%董有海%顧軍%程根祥
황패언%동유해%고군%정근상
肱骨骨折%骨折固定术,内%解剖
肱骨骨摺%骨摺固定術,內%解剖
굉골골절%골절고정술,내%해부
Humeral fractures%Fracture fixation,internal%Dissection
目的 探讨经皮微创钢板内固定技术(MIPO)治疗肱骨近端骨折的可行性和临床效果.方法 取8具成人尸体上肢标本,经肩峰下2 cm做一4 cm左右横形切口,沿肌纤维走向分层分离肌肉,并经皮沿肌下隧道贴于骨面顺行插入锁定解剖钢板,两端分别用数枚螺钉固定,测定腋神经与肩关节骨性标志间、钢板外侧缘的距离.临床上自2009年3月至2010年9月采用闭合复位、经皮锁定钢板内固定治疗18例肱骨近端骨折患者,男6例,女12例;年龄47～86岁,平均67.4岁.记录手术时间、术中失血量、术后平均住院时间、术后近期并发症、骨折愈合时间及肩、肘关节活动范围.结果 腋神经于肱骨后外侧横过肱骨处至肩峰、肱骨头及肱骨解剖颈下缘的垂直距离平均分别为(69.09±6.07)、(55.54±4.64)及(16.23±2.91)mm.18例患者平均手术时间为(106±36)min,术中失血量为(82±38)mL,术后平均住院时间为(6±2)d.患者术后获8～16个月(平均12.6个月)随访.本组患者术后肩关节功能优9例,良7例,可2例,优良率为88.9%.所有患者伤口均一期愈合,无一例发生医源性腋神经损伤.全部患者骨折均获愈合,平均愈合时间为16.3周(14～36周).结论 采用MIPO技术治疗肱骨近端骨折,其并发症少,临床效果良好.
目的 探討經皮微創鋼闆內固定技術(MIPO)治療肱骨近耑骨摺的可行性和臨床效果.方法 取8具成人尸體上肢標本,經肩峰下2 cm做一4 cm左右橫形切口,沿肌纖維走嚮分層分離肌肉,併經皮沿肌下隧道貼于骨麵順行插入鎖定解剖鋼闆,兩耑分彆用數枚螺釘固定,測定腋神經與肩關節骨性標誌間、鋼闆外側緣的距離.臨床上自2009年3月至2010年9月採用閉閤複位、經皮鎖定鋼闆內固定治療18例肱骨近耑骨摺患者,男6例,女12例;年齡47～86歲,平均67.4歲.記錄手術時間、術中失血量、術後平均住院時間、術後近期併髮癥、骨摺愈閤時間及肩、肘關節活動範圍.結果 腋神經于肱骨後外側橫過肱骨處至肩峰、肱骨頭及肱骨解剖頸下緣的垂直距離平均分彆為(69.09±6.07)、(55.54±4.64)及(16.23±2.91)mm.18例患者平均手術時間為(106±36)min,術中失血量為(82±38)mL,術後平均住院時間為(6±2)d.患者術後穫8～16箇月(平均12.6箇月)隨訪.本組患者術後肩關節功能優9例,良7例,可2例,優良率為88.9%.所有患者傷口均一期愈閤,無一例髮生醫源性腋神經損傷.全部患者骨摺均穫愈閤,平均愈閤時間為16.3週(14～36週).結論 採用MIPO技術治療肱骨近耑骨摺,其併髮癥少,臨床效果良好.
목적 탐토경피미창강판내고정기술(MIPO)치료굉골근단골절적가행성화림상효과.방법 취8구성인시체상지표본,경견봉하2 cm주일4 cm좌우횡형절구,연기섬유주향분층분리기육,병경피연기하수도첩우골면순행삽입쇄정해부강판,량단분별용수매라정고정,측정액신경여견관절골성표지간、강판외측연적거리.림상상자2009년3월지2010년9월채용폐합복위、경피쇄정강판내고정치료18례굉골근단골절환자,남6례,녀12례;년령47～86세,평균67.4세.기록수술시간、술중실혈량、술후평균주원시간、술후근기병발증、골절유합시간급견、주관절활동범위.결과 액신경우굉골후외측횡과굉골처지견봉、굉골두급굉골해부경하연적수직거리평균분별위(69.09±6.07)、(55.54±4.64)급(16.23±2.91)mm.18례환자평균수술시간위(106±36)min,술중실혈량위(82±38)mL,술후평균주원시간위(6±2)d.환자술후획8～16개월(평균12.6개월)수방.본조환자술후견관절공능우9례,량7례,가2례,우량솔위88.9%.소유환자상구균일기유합,무일례발생의원성액신경손상.전부환자골절균획유합,평균유합시간위16.3주(14～36주).결론 채용MIPO기술치료굉골근단골절,기병발증소,림상효과량호.
Objective To explore the feasibility and clinical effects of minimally invasive percutaneous plate osteosynthesis (MIPO) for humeral surgical neck fractures.Methods In 8 cadaveric specimens of adult upper limbs, a 4 cm transverse incision was made about 2 cm subacromially along the muscle fibers to dissect the muscle layers.A percutaneous locking plate was inserted along the submuscular tunnel and close to the bone surface before it was fixated at both ends with screws.The distances between the axillary nerve and the bony signs of the shoulder, as well as the distances between the axillary nerve and the lateral edges of the plate, were measured.From March 2009 to September 2010, the percutaneous locking plate was used to treat 18 cases of humeral surgical neck fractures after closed reduction.They were 6 men and 12 women, aged from 47 to 86 years (average, 67.4 years).Operation time, blood loss, postoperative hospital stay, postoperative complications, fracture healing time, and ranges of motion of the shoulder and the elbow were documented.Results The distances between the axillary nerve and the acromion, the humeral head and the lower edge of the humeral anatomical neck were respectively 69.09 + 6.07, 55.54 +4.64 and 16.23 +2.91 mm.The 18 patients were followed up for 8 to 16 months (average, 12.6 months).On average, the operative time was 106 + 36 min, intraoperative blood loss 82 + 38 mL, and postoperative hospital stay 6 + 2 days.All fractures healed without wound infection.The average healing time was 16.3 weeks (from 14 to 36 weeks) .No iatrogenic injury to the axillary nerve occurred. Conclusion MIPO is a fine treatment for humeral surgical neck fractures.
