CAJ | 학술논문

目的：探讨应用微创锁定接骨板( MIPO)技术治疗非手术治疗失败的肱骨干骨折肥大型骨不连的临床疗效。方法2008年11月至2012年10月运用微创锁定接骨板( MIPO)技术治疗非手术治疗失败的肱骨干骨折肥大型骨不连17例，观察手术时间、输血量、愈合情况、并发症以及功能恢复情况等。结果术中出血平均为180mL(120~300mL)，手术时间60min(40~95min)；术中未输血；术后患者切口均Ⅰ期愈合，无感染等并发症发生。本组17例，其中14例(82．3%)获得随访，随访时间8~22个月，平均14．6个月。 X线片示骨折均骨性愈合，其中1例有螺丝钉松动迹象但骨折最终愈合，愈合时间3．5~8个月，平均4．9个月。4例有5°~15°的肘内翻。根据 Constant-Murley肩关节评分及Broberg-Morrey肘关节评分，肩、肘关节功能恢复均满意，其中 Constant-Murley评分术前81．6(67~94)分，术后92．2(80~100)分，肩关节功能：前屈上举162°(100°~180°)；体侧外旋平均52°(35°~90°)，内旋T7-T8(T12-T5)；Broberg-Morrey评分术前80．6(62~90)分，术后94．5(73~100)分，屈曲132°(110°~140°)，伸直16°(0°~35°)，前臂旋转正常。结论微创锁定接骨板( MIPO)技术是治疗非手术治疗失败的肱骨干骨折肥大型骨不连的较好方法，其固定稳定，能最大程度地减少了对骨折端血供的破坏，符合生物学固定原则，但对病例的选择需要慎重。
목적：탐토응용미창쇄정접골판( MIPO)기술치료비수술치료실패적굉골간골절비대형골불련적림상료효。방법2008년11월지2012년10월운용미창쇄정접골판( MIPO)기술치료비수술치료실패적굉골간골절비대형골불련17례，관찰수술시간、수혈량、유합정황、병발증이급공능회복정황등。결과술중출혈평균위180mL(120~300mL)，수술시간60min(40~95min)；술중미수혈；술후환자절구균Ⅰ기유합，무감염등병발증발생。본조17례，기중14례(82．3%)획득수방，수방시간8~22개월，평균14．6개월。 X선편시골절균골성유합，기중1례유라사정송동적상단골절최종유합，유합시간3．5~8개월，평균4．9개월。4례유5°~15°적주내번。근거 Constant-Murley견관절평분급Broberg-Morrey주관절평분，견、주관절공능회복균만의，기중 Constant-Murley평분술전81．6(67~94)분，술후92．2(80~100)분，견관절공능：전굴상거162°(100°~180°)；체측외선평균52°(35°~90°)，내선T7-T8(T12-T5)；Broberg-Morrey평분술전80．6(62~90)분，술후94．5(73~100)분，굴곡132°(110°~140°)，신직16°(0°~35°)，전비선전정상。결론미창쇄정접골판( MIPO)기술시치료비수술치료실패적굉골간골절비대형골불련적교호방법，기고정은정，능최대정도지감소료대골절단혈공적파배，부합생물학고정원칙，단대병례적선택수요신중。
Objective To evaluate the clinical efficiecy of minimally invasive plate osteosynthesis( MIPO) with locking compression plate(LCP) in the treatment of hypertrophic nonunion of humeral shaft fracture for conservative treatment failure. Methods Treated 17 patients with hypertrophic nonunion of humeral shaft fracture for conservative treatment failure with MIPO technique from November 2008 to October 2012. The operation time,amount of blood transfusion,time to union,complications,and functional recovery were recorded and study Results The average amount of bleeding was 180ml(range,120-300ml);The average duration of the surgery was 60 minutes( range,40-95 minutes) with no blood transfusion. All surgical wound healed primarily,and there was no wound infection. 14 of 17 patients were followed up for 8-22 months with an average of 14. 6 months,Radiological ex-amination revealed all fractures healed within 3. 5-8 months with an average of 4. 9 months,although the screws loosened,the frac-ture of one patient eventually healed . All patients recovered normal carry angle except for 4 patients with 5-15° varus deviation. According to the shoulder score of Constant-Murley and the elbow score of Broberg and Morrey. The shouders and elbows of all pa-tients had satisfactory recovery eventually, The Constant-Murley Score was improved from the preoperative 81. 6 to postoperative 92. 2 . The mean forward flexion of the shoulder was 162°(range,100°to 180°),external rotation 52°(range,35°-90°),internal rotation at T7-T8 level(range,T12-T5)The Broberg and Morrey Score was improved from the preoperative 80. 6 to postoperative 94. 5 . The mean flexion of the elbow was 132°(range,110°to 140°),extension 16°(0°-35°),function of the forearm was normal. Conclusion It is the effective method for managing the hypertrophic nonunion of humeral shaft fracture for conservative treatment failure with with Minamally invasive Plate Osteosynthesis(MIPO)technique,It provides stable fixation and least damage to the blood supply of the fractured bone in accordance with biological fixation principle,but it should be meticulous to choose the cases.