目的 探讨后正中入路干骺端锁定加压钢板治疗肱骨干下段骨折的临床效果.方法 选取2010年3月至2013年7月在我院采用干骺端锁定加压钢板治疗肱骨干下段骨折的患者96例,采用随机数表法将患者分为观察组和对照组,各48例,观察组患者采用从后正中入路干骺端锁定加压钢板治疗,对照组患者采用从前外侧入路干骺端锁定加压钢板治疗.观察并比较两组患者的临床愈合时间、肘关节功能评分和并发症评估情况.结果 两组患者均获得了较好的临床愈合,观察组的愈合时间为(8.25±1.59)d,明显短于对照组的(14.84±3.28)d,两组比较差异具有统计学意义(P<0.05);根据肘关节的评分功能,观察组优良率为87.5%(42/48),明显高于对照组的77.1%(37/48),两组比较差异有统计学意义(P<0.05);观察组患者术后出现并发症9例,其中骨折延迟愈合5例,桡神经麻痹2例,前臂外侧皮神经麻痹和切口感染各1例,对照组患者术后出现并发症25例,其中骨折延迟愈合13例,桡神经麻痹5例,前臂外侧皮神经麻痹4例,切口感染3例,两组患者的并发症发生率比较差异有统计学意义(P<0.05).结论 利用后正中入路干骺端锁定加压钢板治疗肱骨干下段骨折可以减少愈合时间,减小并发症的发生,同时可改善肘关节功能和提高肘关节恢复能力,值得在临床上推广.%Objective To explore the clinical efficacy of metaphyseal locking compression plate fixation with posterior midline approach for the treatment of distal humeral shaft fracture. Methods A total of 96 patients with distal humeral shaft fracture, who underwent metaphyseal locking compression plate fixation in our hospital from March 2010 to July 2010, were randomly divided into observation group and control group, with 48 cases in each group. The observa-tion group was treated by metaphyseal locking compression plate fixation with posterior midline approach, while the con-trol group was treated by metaphyseal locking compression plate fixation with anterolateral approach. The fracture heal-ing time, evaluation scores of postoperative elbow-joint function and complications of the two groups were recorded and compared. Results The mean healing time of the observation group was significantly shorter than control group [(8.25±1.59) d vs (14.84 ± 3.28) d, P<0.05]. According to the evaluation scores of postoperative elbow-joint function, the obser-vation group had the significant better excellent rate than control group [87.5%(34 excellent cases, 8 good cases, 4 mid-dle cases, 2 poor cases), 77.1%(22 excellent cases, 15 good cases, 6 middle cases, 5 poor cases), P<0.05]. The observa-tion group had 9 cases of complications, which included 5 cases of delayed union of fractures, 2 cases of paralysis of the radial nerve, 1 case of lateral antebrachial cutaneous nerve paralysis and 1 case of incision infection. The control group had 25 cases of complications, which included 13 cases of delayed union of fractures, 5 cases with paralysis of the radial nerve, 4 cases of lateral antebrachial cutaneous nerve paralysis and 3 cases of incision infection. There was a statistically significant difference between two groups in term of complication rate (P<0.05). Conclusion The treatment of distal humeral shaft fracture with metaphyseal locking compression plate fixation through posterior midline approach can re-duce healing time and the incidence of complications, and improve the elbow joint function and recovery ability of the el-bow joint, which is worth to be promoted in clinical practices.
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