中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2015年
24期
136-140
,共5页
陈孝均%肖继冲%邹永根%张箭%杨杰翔%陶源
陳孝均%肖繼遲%鄒永根%張箭%楊傑翔%陶源
진효균%초계충%추영근%장전%양걸상%도원
微创钢板接骨术%肩峰前外侧入路%肱骨近端骨折%肱骨近端内锁定系统钢板
微創鋼闆接骨術%肩峰前外側入路%肱骨近耑骨摺%肱骨近耑內鎖定繫統鋼闆
미창강판접골술%견봉전외측입로%굉골근단골절%굉골근단내쇄정계통강판
Minimally invasive plate osteosynthesis%Anterolateral acromial approach%Proximal humeral fractures%Proximal humeral internal locking system plate
目的：评价应用微创钢板接骨（minimally invasive plate osteosynthesis，MIPO）技术肱骨近端内锁定系统（Proximal Humeral Internal Locking System，PHILOS）钢板经肩峰前外侧入路治疗肱骨近端骨折的临床疗效。方法：选取2012年4月-2014年3月应用MIPO技术PHILOS钢板经肩峰前外侧入路治疗的38例肱骨近端骨折患者，其中男20例，女18例；年龄27~82岁，平均62.2岁；伤后手术时间2~17 d，平均4.7 d；Neer二部分骨折12例，三部分骨折19例，四部分骨折7例。自肩峰前0.5 cm处向下切开皮肤，长约6 cm，沿肌纤维方向劈开三角肌，显露骨折，直视下间接复位骨折，用克氏针临时固定，在肌层深面向远端插入PHILOS钢板，近端软组织手术窗用5~6枚锁定螺钉固定肱骨头，下方软组织手术窗植入3~4枚螺钉固定肱骨干。结果：本组病例手术时间45~110 min，平均75 min；术中出血60~155 mL，平均95 mL；切口均一期愈合。38例得到平均9.3个月（6~18个月）的随访，骨折均愈合，愈合时间15.2周（11~29周）。术后一年内，肩关节Neer评分优（>90分）19例，良（80~89分）15例，可（71~79分）3例，差（≤70分）1例，优良率为89.5%。结论：应用MIPO技术PHILOS钢板经肩峰前外侧入路治疗肱骨近端骨折具有创伤小、术中出血少、手术时间短、骨折愈合快、肩关节功能恢复好等优点。手术过程中必须对腋神经加以保护。该术式是治疗肱骨近端骨折的一种较好的方法，但与常规的经胸大肌三角肌间隙入路相比，如要明确哪种入路更为优良，则需要进一步增加患者数量来进行比较研究。
目的：評價應用微創鋼闆接骨（minimally invasive plate osteosynthesis，MIPO）技術肱骨近耑內鎖定繫統（Proximal Humeral Internal Locking System，PHILOS）鋼闆經肩峰前外側入路治療肱骨近耑骨摺的臨床療效。方法：選取2012年4月-2014年3月應用MIPO技術PHILOS鋼闆經肩峰前外側入路治療的38例肱骨近耑骨摺患者，其中男20例，女18例；年齡27~82歲，平均62.2歲；傷後手術時間2~17 d，平均4.7 d；Neer二部分骨摺12例，三部分骨摺19例，四部分骨摺7例。自肩峰前0.5 cm處嚮下切開皮膚，長約6 cm，沿肌纖維方嚮劈開三角肌，顯露骨摺，直視下間接複位骨摺，用剋氏針臨時固定，在肌層深麵嚮遠耑插入PHILOS鋼闆，近耑軟組織手術窗用5~6枚鎖定螺釘固定肱骨頭，下方軟組織手術窗植入3~4枚螺釘固定肱骨榦。結果：本組病例手術時間45~110 min，平均75 min；術中齣血60~155 mL，平均95 mL；切口均一期愈閤。38例得到平均9.3箇月（6~18箇月）的隨訪，骨摺均愈閤，愈閤時間15.2週（11~29週）。術後一年內，肩關節Neer評分優（>90分）19例，良（80~89分）15例，可（71~79分）3例，差（≤70分）1例，優良率為89.5%。結論：應用MIPO技術PHILOS鋼闆經肩峰前外側入路治療肱骨近耑骨摺具有創傷小、術中齣血少、手術時間短、骨摺愈閤快、肩關節功能恢複好等優點。手術過程中必鬚對腋神經加以保護。該術式是治療肱骨近耑骨摺的一種較好的方法，但與常規的經胸大肌三角肌間隙入路相比，如要明確哪種入路更為優良，則需要進一步增加患者數量來進行比較研究。
목적：평개응용미창강판접골（minimally invasive plate osteosynthesis，MIPO）기술굉골근단내쇄정계통（Proximal Humeral Internal Locking System，PHILOS）강판경견봉전외측입로치료굉골근단골절적림상료효。방법：선취2012년4월-2014년3월응용MIPO기술PHILOS강판경견봉전외측입로치료적38례굉골근단골절환자，기중남20례，녀18례；년령27~82세，평균62.2세；상후수술시간2~17 d，평균4.7 d；Neer이부분골절12례，삼부분골절19례，사부분골절7례。자견봉전0.5 cm처향하절개피부，장약6 cm，연기섬유방향벽개삼각기，현로골절，직시하간접복위골절，용극씨침림시고정，재기층심면향원단삽입PHILOS강판，근단연조직수술창용5~6매쇄정라정고정굉골두，하방연조직수술창식입3~4매라정고정굉골간。결과：본조병례수술시간45~110 min，평균75 min；술중출혈60~155 mL，평균95 mL；절구균일기유합。38례득도평균9.3개월（6~18개월）적수방，골절균유합，유합시간15.2주（11~29주）。술후일년내，견관절Neer평분우（>90분）19례，량（80~89분）15례，가（71~79분）3례，차（≤70분）1례，우량솔위89.5%。결론：응용MIPO기술PHILOS강판경견봉전외측입로치료굉골근단골절구유창상소、술중출혈소、수술시간단、골절유합쾌、견관절공능회복호등우점。수술과정중필수대액신경가이보호。해술식시치료굉골근단골절적일충교호적방법，단여상규적경흉대기삼각기간극입로상비，여요명학나충입로경위우량，칙수요진일보증가환자수량래진행비교연구。
Objective:To investigate the curative effect of using minimally invasive plate osteosynthesis(MIPO) technique through anterolateral acromial approach for the treatment of proximal humerus fractures with proximal humeral internal locking system(PHILOS)plate.Method:From April 2012 to March 2014,38 cases of proximal humerus fractures were treated with MIPO technique through anterolateral acromial approach with PHILOS plate.There were 20 males and 18 females,and the average age was 62.2 years(range 27-82 years)and the average time was 4.7 days(range,2-17 days)between injury and operation,including 12 cases of Neer Ⅱ,19 cases of Neer Ⅲ,and 7 cases of Neer Ⅳ.Starting from 0.5 cm anterior to the acromion,the skin was incised from 6 cm in length and the deltoid muscle was separated along the muscle fibers to expose the fracture fragments.Under direct vision the indirect reduction of the fracture was performed and the fragments were temporarily fixed with K-wires.The PHILOS plate was inserted distally beneath the deltoid muscle and the position between the distal plate and the humeral shaft was adjusted through another small skin incision on the lateral upper arm.5-6 locking screws were inserted to the proximal plate to fix the fracture fragments while 3-4 screws were inserted to the distal plate to fix it to the humeral shaft. Result:This series experienced a primary wound healing,a mean operation time was 75 min(range,45-110 min),and a mean intraoperative blood loss was 95 mL(range 60-155 mL).All the 38 cases were followed up ranging from 6 to 18 months with an average of 9.3 months.The bone healing time was 15.2 weeks(range 11-29 weeks).The functional results of the shoulder,according to Neer scores was evaluated within 1 year after operation,were classified as excellent in 19 cases,good in 15 cases,fair in 3 cases,and poor in 1 case,the excellent and good rate was 89.5%.Conclusion:Using MIPO technique through anterolateral acromial approach for the treatment of proximal humerus fractures with PHILOS plate allows for preservation of blood supply in fracture fragments,owing to less soft tissue and periosteal injury,that is why anterolateral acromial approach has advantages of less trauma,less blood loss,shorter operative time,rapid recovery of shoulder joint function and fracture. When the procedure is performed with the lateral double incision,preservation of the axillary nerve is necessary.This approach represents an alternative treatment for closed proximal humerus fracture but more extensive studies are needed.
