医学经后方劈肱三肌入路治疗肱骨干中下段骨折.docVIP

经后方劈肱三头肌入路治疗肱骨干中下段骨折 作者：张志成，孙天胜，刘 智，刘树清，任继鑫，吴长青 【关键词】 肱骨干骨折 摘 要：［目的］分析经后方劈肱三头肌入路治疗肱骨干中下段骨折的临床疗效。［方法］回顾分析经后方劈肱三头肌入路治疗并获得随访的32例肱骨干中下段骨折，均经后正中劈肱三头肌入路切开复位钢板固定；对陈旧骨折骨不连患者取对侧髂骨植骨；伴有桡神经损伤者同时探察桡神经。［结果］随访6～48个月，平均263个月。骨折愈合时间3～9个月，平均48个月。骨折不愈合2例，Type B型1例，Type C型1例，年龄均超过65岁；手术致桡神经损伤1例，术后3个月内恢复：1例一过性尺神经麻痹；1例肘关节异位骨化；原切口取出钢板23例，无桡神经损伤。以Mayo肘关节功能评分系统评定：优18例，良7例，可4例，差3例；术后肱三头肌肌力为4～5级。［结论］经后方劈肱三头肌入路可安全清楚的显露肱骨中下段，并能对骨折进行妥善固定，并发症发生率可以接受。 关键词：肱骨干骨折； 钢板固定； 后方入路 Abstract：［Objective］To analysis the therapeutic efficacy of middle and lower thirds fracture of humeral shaft with plate fixation by posterior triceps-splitting approach.［Method］Thirtytwo patients with middle and lower thirds fracture of humeral shaft were fixed with plate by posterior tricepssplitting approach. Bone graft was performed in disunion cases.［Result］The mean followup period was 26.3 months (6～48 months). The mean bone union period was 4.8 months(3～9 months). Disunion appeared in 2 cases(agegt;65 years,Type A in 1, Type B in 1).Radial nerve injury resulted from operation obtained complete recovery 3 months postoperation; 1 case that transient ulnar nerve palsy recovered 3 days after operation; elbow heterotopic ossification in 1 case; there were no radial nerve injury in 23 cases where the plate was removed in same approach. Elbow function evaluated by Mayo Score system were excellent in 18, good in 8, fair in 4, bad in 3. At the last followup, the strength of triceps was about 4～5 grade.［Conclusion］The fracture of middle and lower humeral shaft can be exposed and fixed safely by tricepssplitting approach, the rate of complications was acceptable. Key words：Humeral shaft fracture; Fixation with plate; Posterior approach 作者简介：张志成(1977-)，男，山东省泰安市人，主治医师，硕士在读。研究方向：创伤、脊柱外科。电话：(010Email:dadouzc@126.com 肱骨干中下段骨折在临床上比较多见，治疗方法不当可造成骨折不愈合，影响肘关节功能。由于桡神经与肱骨复杂的解剖关系，需要手术治疗的肱骨干骨折多选择前外侧入路钢板固定，但肱骨下段前外侧骨面形态并不利于钢板的放置，而且容易导致桡神经的医源性损伤，故本院自2001年6月～2005年6月间，采用经后方劈肱三头肌入路治疗且获得随访的32例肱骨干中下段骨折，效果满意，现报告如下。 1 资料与方法 11 一般资料 本组病