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改良联合入路治疗肱骨下段骨折：前外侧和外侧双入路。

Modified combined approach for distal humerus shaft fracture: anterolateral and lateral bimodal approach.

机构信息

Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea.

出版信息

Clin Orthop Surg. 2013 Sep;5(3):209-15. doi: 10.4055/cios.2013.5.3.209. Epub 2013 Aug 20.

DOI:10.4055/cios.2013.5.3.209
PMID:24009907
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3758991/
Abstract

BACKGROUND

Due to the anatomical nature of the radial nerve, dissection and attainment of an adequate operative field in mid to distal humerus fracture is dangerous and limited. We devised a combined anterolateral and lateral approach that ensures protection of the radial nerve. This is achieved by performing bimodal dissection of the proximal humerus anteriorly and the distal humerus laterally.

METHODS

Thirty-five consecutive patients were treated using a combined anterolateral and lateral approach for a minimum follow-up period of 24 months. We analyzed time to bony union, time to return to daily work, range of motion, elbow joint function as assessed by the Mayo elbow performance index and complications.

RESULTS

Radiologic bony union was observed at 11.2 weeks (range, 8 to 20 weeks) on average. Four cases of incomplete radial nerve palsy before surgery all recovered. Time to return to work was 10.2 weeks (range, 2 to 32 weeks) on average. The average range of motion of the elbow was 3.3° (range, 0° to 10°) of extension and 135.9° (range, 125° to 145°) of flexion. There were 21 cases of excellent and 13 cases of good or better recovery, comprising over 97.1% on the Mayo elbow performance index. There were no complications of radial nerve palsy, non-union, mal-union, or infection.

CONCLUSIONS

Our a modified combined anterolateral and lateral approach is a clinically effective surgical method of achieving protection of the radial nerve and securing easy and firm internal fixation.

摘要

背景

由于桡神经的解剖结构，在肱骨中段和远端骨折中进行解剖和获得足够的手术视野是危险且有限的。我们设计了一种联合前外侧和外侧入路，以确保保护桡神经。这是通过在前侧进行肱骨近端的双模态解剖和在外侧进行肱骨远端的双模态解剖来实现的。

方法

连续 35 例患者采用联合前外侧和外侧入路治疗，随访时间至少为 24 个月。我们分析了骨愈合时间、恢复日常工作的时间、活动范围、肘关 节功能（采用 Mayo 肘功能评分评估）和并发症。

结果

平均 11.2 周（8 至 20 周）观察到影像学骨愈合。术前有 4 例不完全桡神经麻痹，均恢复。平均恢复工作时间为 10.2 周（2 至 32 周）。平均肘关 节活动范围为 3.3°（0°至 10°）伸展和 135.9°（125°至 145°）屈曲。Mayo 肘功能评分，优 21 例，良或可 13 例，占 97.1%以上。无桡神经麻痹、骨不连、畸形愈合或感染等并发症。

结论

我们改良的联合前外侧和外侧入路是一种临床有效的手术方法，可保护桡神经，确保内固定的简便和牢固。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/167375b4531a/cios-5-209-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/3a2df696deb2/cios-5-209-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/2b06ecdb20e5/cios-5-209-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/1f2b1827b219/cios-5-209-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/e59c4b9a8618/cios-5-209-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/f196056a7d11/cios-5-209-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/167375b4531a/cios-5-209-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/3a2df696deb2/cios-5-209-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/2b06ecdb20e5/cios-5-209-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/1f2b1827b219/cios-5-209-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/e59c4b9a8618/cios-5-209-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/f196056a7d11/cios-5-209-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8d8/3758991/167375b4531a/cios-5-209-g006.jpg

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