Atlanta Medical Center, Department of Orthopaedics, Atlanta, GA, USA.
Injury. 2010 Oct;41(10):1047-52. doi: 10.1016/j.injury.2010.04.021.
The purpose of the present study was to evaluate percutaneous sub-muscular internal fixation using a locked screw methodology for treatment of diaphyseal humeral fractures.
Inclusion criteria were multiple extremity fractures, open fractures, neurovascular injuries,additional ipsilateral upper extremity fractures, the inability to obtain a satisfactory closed reduction and isolated fractures with circumstances that prevented effective bracing. Exclusion criteria were immaturity, neoplasm, infection and intra-articular extensions in the same bone. Outcome measures included clinical and radiographic healing, complications, elbow and shoulder symptoms, range of motion (ROM) and Constant–Murley (CM) scores.
Thirty-one patients with 32 fractures were evaluated with a mean follow-up of 16 months (3–38 months). There was radiographic healing in 31 out of the 32 fractures; the non-union was revised to open plating at 6 months and healed uneventfully. Hardware complications included two construct disengagements; one patient was revised and healed, and the other achieved union with bracing.Neurovascular complications included one preoperative nerve palsy that recovered by 3 months, two partial to complete postoperative nerve palsies that recovered by 6 months, and one intact-to-complete nerve palsy due to a bone fragment that required decompression with full recovery by 3 weeks. All patients had functional ROM with a mean CM score of 88. There were no elbow complaints and minor shoulder dysfunction occurred in two patients with ipsilateral shoulder injuries. The rate of neurovascular complications was comparable to open plating techniques and all patients had full recovery.
We feel sub-muscular anterior plating of the humerus using locking screw technology is a viable and useful method for diaphyseal humeral fractures.
本研究旨在评估经皮肌肉下锁定螺钉内固定治疗肱骨干骨折的效果。
纳入标准为：多发四肢骨折、开放性骨折、神经血管损伤、同侧上肢其他骨折、无法获得满意的闭合复位以及存在影响有效支具固定的其他情况的单纯骨折。排除标准为：未成年、肿瘤、感染以及同一骨骼的关节内延伸。主要观察指标为临床和影像学愈合、并发症、肘和肩部症状、活动范围（ROM）和Constant–Murley（CM）评分。
31 例 32 处骨折患者接受了评估，平均随访时间为 16 个月（3～38 个月）。32 处骨折中有 31 处实现了影像学愈合；1 处骨折在 6 个月时出现骨不连，改为切开复位钢板内固定后愈合良好。内固定物相关并发症包括 2 处固定装置脱离，1 例患者经翻修后愈合，另 1 例通过支具固定后实现了愈合。神经血管并发症包括 1 例术前神经麻痹，术后 3 个月恢复；2 例部分至完全性术后神经麻痹，术后 6 个月恢复；1 例因骨块导致的完整至完全性神经麻痹，术后 3 周行减压后完全恢复。所有患者的功能 ROM 平均 CM 评分为 88 分。无肘部抱怨，2 例同侧肩部损伤患者存在轻微肩部功能障碍。神经血管并发症的发生率与切开复位钢板内固定技术相当，所有患者均完全恢复。
我们认为使用锁定螺钉技术进行肱骨干的肌肉下前侧钢板内固定是一种可行且有效的治疗肱骨干骨折的方法。
