Service d'orthopédie traumatologie, hôpital central de Yaoundé, Yaoundé, Cameroon.
Service d'orthopédie traumatologie, hôpital central de Yaoundé, Yaoundé, Cameroon.
Orthop Traumatol Surg Res. 2018 Oct;104(6):847-851. doi: 10.1016/j.otsr.2018.04.006. Epub 2018 May 16.
Humeral plating osteosynthesis is controversial, particularly regarding the choice between anterior and lateral approach, data for which in the context of a low-income country are lacking.
The anterior approach is an easy surgical technique, allowing good anatomic reconstruction. We hypothesize that the anterior approach is associated with fewer neurovascular lesions and functional sequelae than the lateral approach.
A retrospective study with assessment update was carried out over a period of 6years 4months from January 2010 to June 2016, with consecutive recruitment in the city of Yaoundé, Cameroon. It consisted in a review of medical records, with physical reassessment on pre-designed and tested data-sheet. Sixty-two osteosyntheses were documented in 60 subjects operated on for humeral fracture or non-union. The following variables were studied: sociodemographic data, fracture profile, clinical profile, and functional shoulder and elbow results. Data analysis used the Statistical Package for Social Sciences (SPSS), version 23.0. Associations between qualitative variables were assessed on Chi square test, or Fisher test when the expected sample size was less than 5, and between quantitative and qualitative variables on Student t-test for comparison of means; p values≤0.05 were considered statistically significant.
The anterior approach showed better results. Operative time was shorter, at 102.5min on average, for 262cm blood loss, versus 141.6min and 330cm on the lateral approach, with a significant correlation between the two variables. The incidence of postoperative radial paralysis was significantly higher with the lateral approach (22.6% versus 3.2%; p=0.02), and there were likewise higher rates of postoperative infection (9.7% versus 6.5%), secondary displacement, implant damage, and malunion. Reduction was more often anatomical with the anterior approach (28.1% versus 11%) and cortical fixation was better (83.9% versus 61.3%). Functional shoulder and elbow recovery was nearly normal with both approaches, with superimposable values and no statistically significant difference in (p=0.4).
Cameroon being a low-income country, the anterior approach is of therapeutic and prognostic interest, being easy to perform, with a low rate of postoperative complications and good functional outcome.
肱骨钢板内固定术存在争议，尤其是在前侧和外侧入路的选择方面，在低收入国家中缺乏相关数据。
前侧入路是一种简单的手术技术，可以实现良好的解剖重建。我们假设前侧入路与外侧入路相比，发生神经血管损伤和功能后遗症的风险更低。
回顾性研究，评估时间更新为 2010 年 1 月至 2016 年 6 月的 6 年 4 个月，在喀麦隆雅温得市连续招募患者。该研究包括病历回顾，并使用预先设计和测试的数据表进行体格检查。共记录了 62 例肱骨骨折或骨不连患者的 60 例手术。研究变量包括社会人口统计学数据、骨折特征、临床特征以及肩部和肘部的功能结果。数据分析使用 SPSS 统计软件（版本 23.0）。采用卡方检验评估定性变量之间的关系，预期样本量小于 5 时采用 Fisher 检验，定量和定性变量之间采用学生 t 检验进行比较，p 值≤0.05 为差异有统计学意义。
前侧入路效果更好。手术时间更短，平均为 102.5 分钟，失血量为 262cm³，而外侧入路的手术时间为 141.6 分钟，失血量为 330cm³，两者呈显著相关。术后桡神经麻痹的发生率在外侧入路明显更高（22.6%比 3.2%；p=0.02），术后感染（9.7%比 6.5%）、二次移位、植入物损坏和畸形愈合的发生率也更高。前侧入路的复位更常为解剖复位（28.1%比 11%），皮质固定更好（83.9%比 61.3%）。两种方法的肩部和肘部功能恢复几乎正常，具有相似的数值，且在（p=0.4）方面无统计学差异。
喀麦隆是一个低收入国家，前侧入路具有治疗和预后意义，操作简单，术后并发症发生率低，功能恢复良好。
