CAJ | 학술논문

目的对比传统经后侧入路切开复位内固定技术与微创前置钢板固定(MIAPO)技术对肱骨干中下段血供的影响. 方法采用健康成人新鲜冷冻上肢标本6对(12具),男4对,女2对;死亡年龄54 ～ 87岁(平均68.3岁).每对为一组(左、右各一具),随机选择左、右侧分别行经后侧入路切开复位内固定术和MIAPO技术后,所有标本经腋动脉灌注乳胶-四氧化三铅液,行X线片检查并解剖观察,对比分析肱骨中下段主要动脉分支的走形与手术破坏情况. 结果全部12具标本肱骨干中下段均只有1支主要滋养动脉,分别于肱骨干前内侧面[10/12(83.3％)]和内侧面[2/12(16.7％)]进入肱骨.对于肱骨干后侧的辅助滋养动脉(共17支),MIAPO技术未予破坏(0支),而后侧入路切开复位内固定术则有不同程度的破坏(9支,52.9％).在骨膜充盈方面,MIAPO技术也优于后侧入路切开复位内固定术:差异明显3对,中度差异2对,轻度差异1对. 结论与传统经后侧入路切开复位内固定技术相比,采用MIAPO技术固定肱骨中下段骨折可在避免造成术中医源性桡神经损伤的同时,对肱骨中下段血供的影响较小.
목적 대비전통경후측입로절개복위내고정기술여미창전치강판고정(MIAPO)기술대굉골간중하단혈공적영향. 방법 채용건강성인신선냉동상지표본6대(12구),남4대,녀2대;사망년령54 ～ 87세(평균68.3세).매대위일조(좌、우각일구),수궤선택좌、우측분별행경후측입로절개복위내고정술화MIAPO기술후,소유표본경액동맥관주유효-사양화삼연액,행X선편검사병해부관찰,대비분석굉골중하단주요동맥분지적주형여수술파배정황. 결과 전부12구표본굉골간중하단균지유1지주요자양동맥,분별우굉골간전내측면[10/12(83.3％)]화내측면[2/12(16.7％)]진입굉골.대우굉골간후측적보조자양동맥(공17지),MIAPO기술미여파배(0지),이후측입로절개복위내고정술칙유불동정도적파배(9지,52.9％).재골막충영방면,MIAPO기술야우우후측입로절개복위내고정술:차이명현3대,중도차이2대,경도차이1대. 결론 여전통경후측입로절개복위내고정기술상비,채용MIAPO기술고정굉골중하단골절가재피면조성술중의원성뇨신경손상적동시,대굉골중하단혈공적영향교소.
Objective To compare minimal invasive anterior plating osteosynthesis (MIAPO) and conventional plating osteosynthesis in terms of influence on the blood supply to the middle and distal third humeral shaft.Methods Six pairs of freshly frozen cadaveric specimens of human upper limb were used for this study.They were from 4 males and 2 females who were 54 to 87 years of age (mean,68.3 years).Each pair had one left and one right upper limb.After MIAPO and conventional plating osteosynthesis were used randomly on the left or right side in each pair of specimens,latex-red lead was then injected through the axillary artery.X-ray and anatomic examinations were conducted to observe the paths and disruptions of main vessels in the middle and distal third humeral shaft.Results There was one main nutrient artery entering the humeral shaft at the anteromedial (83.3％) and medial (16.7％) aspects.MIAPO did not damage the accessory nutrient arteries (altogether 17) at the back of the humeral shafts (0) while the conventional posterior approach damaged them more or less at different levels (9,52.9％).MIAPO also showed superior periosteal filling compared with the conventional posterior approach (significantly better in 3 pairs,moderately better in 2 pairs and mildly better in one pair).Conclusions Compared with the conventional plating,MIAPO leads to less disruption to the blood supply to the middle and distal third humeral shaft while it avoids intraoperative iatrogenic injury to the radial nerve.