An Zhiquan, He Xiaojian, Jiang Chaolai, Song Sa, Zhang Changqing
Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Dec;24(12):1413-5.
To compare the effectiveness of two minimally invasive methods: minimally invasive plating osteosynthesis (MIPO) and expandable intramedullary nailing technique in treatment of middle third humeral shaft fractures.
The clinical data were retrospectively analyzed and compared from 33 cases with middle third humeral shaft fractures between May 2004 and December 2008. All the patients were divided into 2 groups: 14 patients were treated with MIPO technique (group A) and 19 with expandable intramedullary nailing technique (group B). In group A, there were 10 males and 4 females with an average age of 35 years (range, 21-51 years). The disease cause was traffic accident in 5 cases, tumbling in 6 cases, machine related trauma in 2 cases, crushed by a heavy object in 1 case. Six fractures were classified as AO type A, 6 as type B, and 2 as type C. The time from injury to operation was 3 to 11 days with an average of 5.9 days. In group B, there were 12 males and 7 females with an average age of 40 years (range, 19-68 years). The disease cause was traffic accident in 7 cases, tumbling in 8 cases, falling from height in 3 cases, crush injury in 1 case. Ten fractures were classified as AO type A, 8 as type B, and 1 as type C. The time from injury to operation was 2 to 6 days with an average of 4.2 days. There was no significant difference in general data between 2 groups (P > 0.05).
The operation time was (104.6 +/- 25.8) minutes in group A and (85.0 +/- 35.7) minutes in group B, showing no significant difference (P > 0.05). Incision healed by first intention without iatrogenic radial nerve palsy in 2 groups. The patients were followed up 21.4 months on average (range, 12-37 months) in group A and 20.5 months on average (range, 22-35 months) in group B. The X-ray films showed bony healing in all patients. The fracture union time was (16.4 +/- 6.1) weeks in group A and (15.0 +/- 2.5) weeks in group B, showing no significant difference (P > 0.05). The University of California Los Angeles (UCLA) End-Result scores were 34.1 +/- 1.1 in group A and 31.8 +/- 2.6 in group B and the Mayo Elbow Performance scores were 100 in group A and 97.6 +/- 3.9 in group B; all showing significant differences (P < 0.05).
Good clinical outcomes could be obtained when middle third humeral shaft fractures are treated by either MIPO or expandable intramedullary nailing techniques. However, MIPO technique could offer better shoulder and elbow functional results.
比较两种微创方法，即微创钢板接骨术（MIPO）和可膨胀髓内钉技术治疗肱骨干中1/3骨折的疗效。
回顾性分析2004年5月至2008年12月间33例肱骨干中1/3骨折患者的临床资料并进行比较。所有患者分为2组：14例采用MIPO技术治疗（A组），19例采用可膨胀髓内钉技术治疗（B组）。A组中，男性10例，女性4例，平均年龄35岁（范围21 - 51岁）。病因：交通事故5例，跌倒6例，机器相关创伤2例，重物挤压1例。6例骨折分类为AO A型，6例为B型，2例为C型。受伤至手术时间为3至11天，平均5.9天。B组中，男性12例，女性7例，平均年龄40岁（范围19 - 68岁）。病因：交通事故7例，跌倒8例，高处坠落3例，挤压伤1例。10例骨折分类为AO A型，8例为B型，1例为C型。受伤至手术时间为2至6天，平均4.2天。两组一般资料比较差异无统计学意义（P > 0.05）。
A组手术时间为（104.6 ± 25.8）分钟，B组为（85.0 ± 35.7）分钟，差异无统计学意义（P > 0.05）。两组切口均一期愈合，无医源性桡神经麻痹。A组患者平均随访21.4个月（范围12 - 37个月），B组平均随访20.5个月（范围22 - 35个月）。X线片显示所有患者均骨性愈合。A组骨折愈合时间为（16.4 ± 6.1）周，B组为（15.0 ± 2.5）周，差异无统计学意义（P > 0.05）。A组加利福尼亚大学洛杉矶分校（UCLA）最终结果评分为34.1 ± 1.1，B组为31.8 ± 2.6；A组梅奥肘关节功能评分100分，B组为97.6 ± 3.9；差异均有统计学意义（P < 0.05）。
采用MIPO或可膨胀髓内钉技术治疗肱骨干中1/3骨折均可获得良好的临床疗效。然而，MIPO技术能提供更好的肩、肘关节功能结果。
