手术-肱骨干骨折桥接钢板内固定术.docxVIP

1.1、原则 桥接钢板 Bridge plating uses the plate as an extramedullary splint, fixed to the two main fragments, while the intermediate fracture zone is left untouched. Anatomical reduction of the shaft fragments is not necessary. Furthermore, direct manipulation risks disturbing their blood supply. If the soft tissue attachments are preserved, and the fragments are relatively well aligned, healing is predictable. 桥接钢板把钢板作为髓外夹板，固定两个主要骨折端，而骨折区域不予干预，肱骨干骨折不必解剖复位，并且，直接操作复位有干扰骨折端血供的风险，如果保留软组织的连续，骨折愈合可能性增加。 Alignment of the main shaft fragments can usually be achieved indirectly utilizing traction and soft tissue tension. 主要骨折块的对位对线可以通过间接使用牵开器和软组织附着性来完成。 Mechanical stability, provided by the bridging plate, is adequate for indirect healing (callus formation). Occasionally, a larger wedge fragment might be approximated to the main fragments with a lag screw. Lag screws should be avoided when there are multiple fragments 桥接钢板提供稳定性，对于骨折二期愈合（骨痂愈合）是充足的，个别情况下，一个大的楔形骨折需要用拉力螺钉固定到主要骨折块，在多段骨折情况下避免使用拉力螺钉。 1.2 ? 桥接钢板的置入??Bridge plate insertion Bridge plates can be inserted either with an open exposure, or through a minimally invasive (MIO) approach, which leaves soft tissues intact over the fracture site. The latter requires fluoroscopic monitoring. With open bridge plating, it is important to preserve soft-tissue attachments to the fracture fragments. To do this, stable provisional reduction (with external fixation, large distractor, or maintained manual traction), and minimal exposure and manipulation of the fracture zone are important. The bridge plate is applied through an incision just wide enough for the plate. 桥接钢板可以通过切开显露，或通过微创显露置入，在MIO情况下可以保留骨折区域软组织完整性，但其要求术中透视帮助。桥接钢板技术，保留骨折断端软组织连续性是很重要的，为了做到这个，稳定的临时复位（通过外固定架，大的牵开器，持骨器），最小程度显露和操作骨折区域是很重要的，桥接钢板需要手术切口可以置入钢板即可。 ? 1.3? 复位???Reduction It is important to restore axial alignment and rotation. A little shortening of 1 or 2 cm can be accepted in the humerus, and in complex multifragmentary fractures may improve bone contact. Exceptionally, a