后路肱三头肌劈开入路治疗肱骨干骨折术后桡神经麻痹发生率与手术经验的关系：一项回顾性研究。

Relationship between incidence of postoperative radial nerve palsy and surgical experience in the treatment of humeral shaft fractures through a posterior triceps splitting approach: A retrospective study.

机构信息

Department of Orthopedic Surgery, Chungnam National University, School of Medicine, Chungnam National University Hospital, Daejeon, South Korea.

Department of Orthopedic Surgery, TanTan Hospital Shoulder Center, Daejeon, South Korea.

出版信息

Acta Orthop Traumatol Turc. 2021 Aug;55(4):338-343. doi: 10.5152/j.aott.2021.20415.

DOI:10.5152/j.aott.2021.20415

PMID:34464310

Abstract

OBJECTIVE

The aim of this study was to investigate the incidence of postoperative radial nerve palsy (PORNP) after the surgical treatment of humeral shaft fractures through a posterior triceps splitting approach by a single surgeon's experience in a consecutive case series from a single trauma center.

METHODS

In this retrospective study, a total of 118 patients (82male, 36 female;mean age = 48 years, age range = 16 - 80 years)who underwent open reduction and plate fixation through posterior triceps splitting approach due to humeral shaft fractures at a level I trauma center were included. Level of the fractures was categorized as the proximal third, middle third, and distal third of the diaphysis, and then all the fractures were classified according to the AO/OTA classification system. The trend of incidence of PORNP was investigated. All the operations were performed by a single surgeon. The recovery time of PORNP was also recorded.

RESULTS

There were 13 cases of proximal third, 67 cases of middle third, and 38 cases of distal third fracture. Based on AO/OTA classification, there were 29 cases of A1-type, 23 cases of A2-type, 42 cases of A3-type, 17 cases of B2-type, 3 cases of B3-type, and 4 cases of C2-type fracture. The overall incidence of PORNP was 11% (13 cases). All the PORNP cases fully recovered within 10.3 ± 10.4 weeks (range = 1 - 44) with conservative treatment. Incidence of PORNP significantly decreased with increase in surgical experience (P = 0.009). The incidence of radial nerve palsy was not significantly related to the level of the fracture (P = 0.199). The incidence of radial nerve palsy was not significantly related with the fracture pattern according to AO/OTA classification (P = 0.659).

CONCLUSION

Evidence from this study has shown that the incidence of PORNP following the posterior triceps splitting approach for the treatment of humeral shaft fractures is significantly associated with the surgeon's experience.

LEVEL OF EVIDENCE

Level IV, Therapeutic Study.

摘要

目的

本研究旨在通过一位外科医生在单一创伤中心的连续病例系列中，调查后路三头肌劈开入路治疗肱骨干骨折术后桡神经麻痹（PORNP）的发生率。

方法

在这项回顾性研究中，共纳入了 118 例（82 例男性，36 例女性；平均年龄=48 岁，年龄范围 16-80 岁）因肱骨干骨折在一级创伤中心接受后路三头肌劈开入路切开复位钢板固定的患者。骨折部位分为骨干近端三分之一、中段三分之一和骨干远端三分之一，然后根据 AO/OTA 分类系统对所有骨折进行分类。研究了 PORNP 发生率的趋势。所有手术均由一位外科医生完成。还记录了 PORNP 的恢复时间。

结果

近端三分之一有 13 例，中段三分之一有 67 例，骨干远端三分之一有 38 例。根据 AO/OTA 分类，有 29 例 A1 型、23 例 A2 型、42 例 A3 型、17 例 B2 型、3 例 B3 型和 4 例 C2 型骨折。PORNP 的总发生率为 11%（13 例）。所有 PORNP 病例均通过保守治疗在 10.3±10.4 周（范围 1-44 周）内完全恢复。随着手术经验的增加，PORNP 的发生率显著降低（P=0.009）。PORNP 的发生率与骨折部位无显著相关性（P=0.199）。根据 AO/OTA 分类，PORNP 的发生率与骨折模式无显著相关性（P=0.659）。