Shetty M Shantharam, Kumar M Ajith, Sujay Kt, Kini Abhishek R, Kanthi Kiran G
Department of Orthopedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore, India.
Indian J Orthop. 2011 Nov;45(6):520-6. doi: 10.4103/0019-5413.87123.
Minimally invasive plate osteosynthesis (MIPO) technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture.
32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively.
Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22-70 years). Twenty-seven of the thirty-two patients (84.3%) had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70-120 minutes) and mean radiation exposure was 160.3 seconds (range: 100-220 seconds). The mean radiological fracture union time was 12.9 weeks (range: 10-20 weeks). Shoulder function was excellent in 27 cases (84.3%) and good in remaining 5 cases (15.6%) on the UCLA score. Elbow function was excellent in 26 cases (81.2%), good in 5 cases (15.6%), and fair in 1 case (3.1%) who had an associated olecranon fracture that was fixed by tension band wire in the same sitting.
MIPO of the humerus gives good functional and cosmetic results and should be considered one of the management options in the treatment of humeral diaphyseal fractures.
数位作者报告称，微创钢板接骨术（MIPO）技术是一种通过前入路治疗肱骨干骨折的令人满意的方法。然而，已发表的报告均未进行充分随访，也未报告患者的治疗结果。我们采用相同的MIPO技术治疗肱骨干骨折，对患者进行了至少2年的随访，评估了其临床、影像学及功能结果。
本研究纳入了2007年6月至2008年10月间采用MIPO治疗的32例肱骨干骨折成年患者。排除患有代谢性骨病、多发伤以及损伤严重程度评分>16的Gustilo和Anderson 3型开放性骨折患者。所有病例均采用闭合间接复位及MIPO技术锁定钢板固定。记录手术时间、辐射暴露时间及骨折愈合时间。分别采用加州大学洛杉矶分校（UCLA）肩关节评分和梅奥肘关节功能评分评估肩关节和肘关节功能。
本研究的32例患者中，男性19例，女性13例。平均年龄39岁（范围：22 - 70岁）。32例患者中有27例（84.3%）为优势侧骨折。C2型8例；C1和A2型5例；B2型4例；B3、B1和A1型各3例；A3型骨折1例。平均手术时间为91.5分钟（范围：70 - 120分钟），平均辐射暴露时间为160.3秒（范围：100 - 220秒）。平均骨折愈合时间为12.9周（范围：10 - 20周）。根据UCLA评分，27例（84.3%）患者肩关节功能优秀，其余5例（15.6%）良好。26例（81.2%）患者肘关节功能优秀，5例（15.6%）良好，1例（3.1%）肘关节功能一般，该患者同时伴有鹰嘴骨折，术中采用张力带钢丝固定。
肱骨MIPO技术可获得良好的功能及美观效果，应被视为肱骨干骨折治疗的选择之一。
