经皮闭合手法复位结合MIPO技术治疗肱骨干粉碎性骨折

摘要

目的:探讨经皮闭合手法复位结合微创钢板内固定(MIPO)技术治疗肱骨干粉碎性骨折的疗效.方法:我科自2009年10月~2015年12月采用经皮闭合手法复位结合MIPO技术治疗肱骨干粉碎性骨折共15例,其中男9例,女6例,平均年龄(57.3±5.2)岁.所有患者均为新鲜闭合性骨折,未合并有桡神经损伤,受伤至手术时间5~11 d.其中肱骨干粉碎性骨折按照AO分型(B型6例,C型9例),其中有2例肱骨干骨折患者合并有肱骨近端骨折,肱骨近端骨折按Neer分型(二部分骨折2例).术后对肩关节功能(Constant-Murley肩关节评分标准)、肘关节功能(Mayo肘关节评分标准)、骨折愈合时间及并发症情况进行评价.结果:15例患者均获随访,随访时间为12~24月,平均(14.2±3.1)月.所有患者骨折均愈合,骨折愈合时间14~22周,平均(15.8±2.1)周,未发生钢板内固定断裂及桡神经损伤并发症,术后肩关节功能评分,优12例,良1例,可2例,肘关节功能评分,优12例,良2例,可1例.结论:应用经皮闭合手法复位结合MIPO技术治疗肱骨干粉碎性骨折,具有损伤小、不影响骨折端血供、手术时间短、骨折愈合时间短及愈合率高、肩肘关节功能恢复好等优势.%Objective:To evaluate the clinical effectiveness of treatment of comminuted humerus fracture by percutaneous closure manual reduction com-bined with minimally invasive plate osteosynthesis(MIPO) technique.Methods:Fifteen patients with comminuted humerus fractures,admitted to our de-partment and treated with percutaneous closure manual reduction and MIPO technique between October 2009 and December 2015 were included.Nine pa-tients were male and 6 were female,with an average of (57.3±5.2)years.All patients were fresh closed fractures without radial nerve injury.Treatment oc-curred between 5 and 11 days following fracture.By AO classification for comminuted humerus fractures,6 cases were associated with type B and 9 with type C,and 2 of the 15 patients were involved in fractures of humeral shaft and proximal humeral neck .By Neer′s classification for proximal humerus frac-ture,and two-part fracture in 2.Postoperative evaluation was performed regarding shoulder joint function by Constant-Murley shoulder joint function sco-ring,elbow function by Mayo elbow scoring,fracture healing time and complications.Results:Fifteen patients were followed after operation.The follow-up ranged from 12 to 24 months with an average of (14.2±3.1) months.Fracture healing occurred in between 14 and 22 weeks,with an average of(15.8±2. 1) weeks.No incidence,including broken plate following internal fixation,damage to the radial nerve and complications occurred.Constant-Murley assess-ment of the shoulder joint function indicated excellent in 12 cases,good in 1 and fair in 2.Elbow function assessment showed that 12 patients were in ex-cellent recovery,2 in good recovery and 1 in fair recovery.Conclusion:Treatment of the comminuted humerus fracture by combined percutaneous closure manual reduction with MIPO technique may have many advantages,including minimal invasion,free impact on the blood supply at the fracture sites,short-ened operative time,early and better fracture healing as well as sound recovery of the elbow function.