后外侧入路肱骨远端关节外解剖锁定钢板内固定治疗肱骨中下段骨折的疗效观察
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摘要
目的探讨后外侧入路肱骨远端关节外解剖锁定钢板内固定治疗肱骨中下段骨折的临床疗效和特点。方法回顾性分析自2012-01—2016-09采用后外侧入路肱骨远端关节外解剖锁定钢板内固定治疗的34例肱骨中下段骨折。后外侧切口下端位于尺骨鹰嘴桡侧缘与肱骨外髁连线的中点,沿肱三头肌的桡侧缘向上可达三角肌下缘,在肱三头肌外侧头与肱二头肌之间的肌间隔分离,肱骨远端关节外解剖锁定钢板置于肱骨中下段背侧稍偏桡侧和肱骨远端桡侧柱的背侧。结果 34例均获得随访,随访时间平均14.4(12～24)个月。术后切口一期愈合,无感染、内固定断裂、骨折不愈合及再骨折等并发症发生。骨折临床愈合时间平均3.5(3～5)个月。6例桡神经损伤者均恢复正常肌力,2例虎口区感觉部分恢复。末次随访疗效采用肘关节功能Mayo评分标准评定:优30例,良4例,优良率100%。结论采用后外侧入路肱骨远端关节外解剖锁定钢板内固定治疗肱骨中下段骨折术中完全在肌间隙分离,桡神经显露充分,创伤小,内固定可靠,效果良好,尤其适用于合并桡神经损伤的患者。
Objective To explore the outcomes and characteristics of anatomical locking extra-articular distal humerus plate by posterolateral approach for treatment of mid-lower humeral fractures. Methods From January 2012 to September 2016,thirty-four cases of mid-lower humeral fractures operated with anatomical locking extra-articular distal humerus plate by posterolateral approach were retrospectively studied. The distal end of the incision was located at the midpoint of the connection line between the radial edge of the ulna falciparum and the outer condyle of the humerus, then along the gap between the triceps muscle and the biceps muscle, the proximal end of the incision reached the lower edge of the deltoid muscle. The plate was placed slightly radial on the dorsal side of the middle and lower segment of the humerus and the dorsal side of the radial column of the distal humerus. Results All patients were followed up for an average 14.4(12-24) months.There were no complications such as infection, broken internal fixation, nonunion and re-fracture. The average clinical healing time of fractures was 3.5(3-5) months. In 6 cases with radial nerve injury, all the muscle strength restored to normal, the feeling in the hand in 2 cases partially restored. The last follow-up effect assessed by Mayo score of the elbow joint function were excellent in 30 cases and good in 4 cases, the excellent and good rate was 100%. Conclusion Anatomical locking extra-articular distal humerus plate by posterolateral approach for treatment of mid-lower humeral fractures has characteristics of good exposure of radial nerve as operation performed in the muscle gap, reliable internal fixation and better outcomes, that is specially indicated for patient associated with radial nerve injury.
Objective To explore the outcomes and characteristics of anatomical locking extra-articular distal humerus plate by posterolateral approach for treatment of mid-lower humeral fractures. Methods From January 2012 to September 2016,thirty-four cases of mid-lower humeral fractures operated with anatomical locking extra-articular distal humerus plate by posterolateral approach were retrospectively studied. The distal end of the incision was located at the midpoint of the connection line between the radial edge of the ulna falciparum and the outer condyle of the humerus, then along the gap between the triceps muscle and the biceps muscle, the proximal end of the incision reached the lower edge of the deltoid muscle. The plate was placed slightly radial on the dorsal side of the middle and lower segment of the humerus and the dorsal side of the radial column of the distal humerus. Results All patients were followed up for an average 14.4(12-24) months.There were no complications such as infection, broken internal fixation, nonunion and re-fracture. The average clinical healing time of fractures was 3.5(3-5) months. In 6 cases with radial nerve injury, all the muscle strength restored to normal, the feeling in the hand in 2 cases partially restored. The last follow-up effect assessed by Mayo score of the elbow joint function were excellent in 30 cases and good in 4 cases, the excellent and good rate was 100%. Conclusion Anatomical locking extra-articular distal humerus plate by posterolateral approach for treatment of mid-lower humeral fractures has characteristics of good exposure of radial nerve as operation performed in the muscle gap, reliable internal fixation and better outcomes, that is specially indicated for patient associated with radial nerve injury.
引文
[1]高秋明,厉孟,樊晓海,等.改良手术入路钢板内固定治疗肱骨中下段骨折[J].中国骨与关节损伤杂志,2013,28(3):231-232.
[2]曹鑫,陈慧锦,孟险峰,等.直型锁定加压钢板与解剖锁定钢板内固定治疗成人肱骨干下段骨折的疗效比较[J].中国骨与关节损伤杂志,2017,32(11):1210-1211.
[3] Capo JT,Debkowska MP,Liporace F,et al. Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate[J]. Int Orthop,2014,38(5):1037-1043.
[4] Watson JD,Kim H,Becker EH,et al. Are two plates necessary for extraarticular fractures of the distal humerus?[J]. Curr Orthop Pract,2014,25(5):462-466.
[5] Morrey BF,Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow[J]. J Bone Joint Surg Am,1992,74(4):479-490.
[6] Poon PC,Foliaki S,Young SW,et al. Triceps split and snip approach to the elbow:surgical technique and biomechanical evaluation[J].ANZ J Surg,2013,83(10):774-778.
[7]徐杏荣,冯万文,李向东,等.经保留伸肘装置的后侧入路手术治疗成人肱骨远端骨折[J].中国修复重建外科杂志,2014,28(7):921-922.
[8] Muhldorfer-Fodor M,Bekler H,Wolfe VM,et al. Paratricipital-triceps splitting “two-window” approach for distal humerus fractures[J]. Tech Hand Up Extrem Surg,2011,15(3):156-161.
[9] Yin P,Zhang L,Mao Z,et al. Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures[J]. Injury,2014,45(7):1121-1125.
[10] Gerwin M,Hotchkiss RN,Weiland AJ,et al. Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve[J]. J Bone Joint Surg Am,1996,78(11):1690-1695.
[11]陶然,徐华,王友华,等.肱骨远端C型骨折三种双钢板固定方法疗效比较[J].中华创伤杂志,2013,29(1):43-48.
[12]张欣,杨军,王维,等.双钢板与单钢板内固定治疗AO-C型肱骨中下段骨折的早期疗效比较[J].中国骨与关节损伤杂志,2018,33(9):925-928.
[13]李庭,蒋协远,公茂琪,等.解剖型平行双钢板和垂直双钢板治疗肱骨髁间骨折[J].中华创伤杂志,2013,29(5):401-406.
[14]钟志年,袁艾东,何正言,等.内侧解剖钢板结合外侧重建钢板在肱骨下段骨折治疗中的应用[J].中国临床研究,2013,26(4):356-357.
[15]罗湘平,何顺清,李治安,等.后外侧入路双钢板内固定治疗肱骨中下段骨折[J].中国骨与关节损伤杂志,2017,32(5):529-530.
[2]曹鑫,陈慧锦,孟险峰,等.直型锁定加压钢板与解剖锁定钢板内固定治疗成人肱骨干下段骨折的疗效比较[J].中国骨与关节损伤杂志,2017,32(11):1210-1211.
[3] Capo JT,Debkowska MP,Liporace F,et al. Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate[J]. Int Orthop,2014,38(5):1037-1043.
[4] Watson JD,Kim H,Becker EH,et al. Are two plates necessary for extraarticular fractures of the distal humerus?[J]. Curr Orthop Pract,2014,25(5):462-466.
[5] Morrey BF,Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow[J]. J Bone Joint Surg Am,1992,74(4):479-490.
[6] Poon PC,Foliaki S,Young SW,et al. Triceps split and snip approach to the elbow:surgical technique and biomechanical evaluation[J].ANZ J Surg,2013,83(10):774-778.
[7]徐杏荣,冯万文,李向东,等.经保留伸肘装置的后侧入路手术治疗成人肱骨远端骨折[J].中国修复重建外科杂志,2014,28(7):921-922.
[8] Muhldorfer-Fodor M,Bekler H,Wolfe VM,et al. Paratricipital-triceps splitting “two-window” approach for distal humerus fractures[J]. Tech Hand Up Extrem Surg,2011,15(3):156-161.
[9] Yin P,Zhang L,Mao Z,et al. Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures[J]. Injury,2014,45(7):1121-1125.
[10] Gerwin M,Hotchkiss RN,Weiland AJ,et al. Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve[J]. J Bone Joint Surg Am,1996,78(11):1690-1695.
[11]陶然,徐华,王友华,等.肱骨远端C型骨折三种双钢板固定方法疗效比较[J].中华创伤杂志,2013,29(1):43-48.
[12]张欣,杨军,王维,等.双钢板与单钢板内固定治疗AO-C型肱骨中下段骨折的早期疗效比较[J].中国骨与关节损伤杂志,2018,33(9):925-928.
[13]李庭,蒋协远,公茂琪,等.解剖型平行双钢板和垂直双钢板治疗肱骨髁间骨折[J].中华创伤杂志,2013,29(5):401-406.
[14]钟志年,袁艾东,何正言,等.内侧解剖钢板结合外侧重建钢板在肱骨下段骨折治疗中的应用[J].中国临床研究,2013,26(4):356-357.
[15]罗湘平,何顺清,李治安,等.后外侧入路双钢板内固定治疗肱骨中下段骨折[J].中国骨与关节损伤杂志,2017,32(5):529-530.
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