微创钢板内固定技术经前方入路治疗肱骨粉碎骨折临床研究

目的探讨微创钢板内固定技术（MWO技术）经前方微创入路治疗肱骨粉碎骨折的临床疗效。方法2009年9月～2012年3月我科室运用MIPO技术治疗17例粉碎肱骨骨折（AO分型：B型10例C型7例），所有病例均采取闭合牵引复位，经肱骨前方肌肉隧道置入LCP板，C臂机透视力线满意后固定，术后指导患者功能锻炼。结果本组17例患者术后随访18-24月，平均21月，骨折4-6月均一期愈合，平均5个月愈合。1例术后出现桡神经麻痹症状，术后10周完全恢复，1例患者因合并肱骨近端骨折，钢板位置较高，发生肩峰撞击综合症，物理治疗后好转。按Neer评分，肩关节活动优9例，良7例，差1例，优良率（94．1％）。结论运用MIPO技术经前方入路治疗肱骨粉碎骨供破坏少，固定牢靠，骨折愈合率高，无需暴露桡神经，这是非常安全有效的治疗措施。

CLINICAL RESEARCH ON THE TREATMENT OF COMMINUTED HUMERAL FRACTURE THROUGH MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS

Objective： To investigate the effect of minimally invasive plate osteosynthesis in the treatment of comminuted humeral fracture via the anterior minimally invasive approach. Methods： From September 2009 to March 2012, a total of 17 patients with comminuted humeral fracture （type B 10 cases and type C 7 cases accordinging to AO classification） in our department were treated by minimally invasive plate osteosynthesis. In all cases, closed traction reduction was used, the LCP was inserted through the muscular tunnel, and fixed with the help of the C-arm machine, functional exercises were conducted for the patients after the operation. Results, Follow-up was carried out on 17 patients for 18 - 24 months with equal 21 months. In the patients, the fracture was healed in 4-6 months after the operation. One patient showed the radial nerve palsy symptoms, completely recover 10 weeks after the operation. Due to complicated proximal humeral fractures, plate position was higher, acromion impingement syndrome occurred, one patient had a good recovery after physical therapy. According to Neer score, the excellent good rate of shoulder joint function was 94.1%, excellent in 9 cases, good in 7 cases, and poor in 1 cases. Conclusion： Minimally invasive plate osteosynthesis in the treatment of humeral comminuted fracture via the anterior minimally invasive approach with less destruction of blood supply, reliable fixation, unnecessary exploding radial nerve, high rate of fracture healing, is a very safe and effective treatment measure.