Ji Jong-Hun, Jeong Ho-Seung, Ko Ban-Suk, You Hwang-Yong, Jun Hyun-Sik
Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea.
Department of Orthopedic Surgery, Chungbuk National University Hospital, Cheongju, Korea.
Clin Orthop Surg. 2024 Dec;16(6):971-978. doi: 10.4055/cios23272. Epub 2024 Nov 15.
This study compares the difference in the clinical and radiologic outcomes when minimally invasive plate osteosynthesis (MIPO) technique is performed with or without using a positional screw in the treatment of humeral shaft fractures.
From January 2010 to January 2021, a retrospective study was conducted on a total of 63 patients who underwent the MIPO technique for the treatment of humeral shaft fractures. We divided these patients into 2 groups: in group I, patients underwent MIPO without a positional screw; in group II, patients underwent MIPO with a positional screw. We compared functional outcomes including the American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, Simple Shoulder Test, range of motion before and after surgery, operation time, blood loss, and complications. And we compared radiologic outcomes including pre- and postoperative anteroposterior (AP) and lateral displacement of the fracture and union time on plain radiographs.
The average patient age was 64.6 ± 15.1 years (range, 25-88 years). Group I consisted of 30 patients (10 men and 20 women), and group II consisted of 33 patients (11 men and 22 women). Between the 2 groups, there was no statistically significant difference in sex, body mass index, functional scores, AP and lateral displacement of the fracture on postoperative x-ray, operation time, and blood loss. In group II, a faster bony union was obtained than that in group I (4.6 vs. 6.4 months). Complications included 2 cases of transient radial nerve palsy in both groups and metallic failures (2 in group I and 1 in group II).
When performing MIPO for humeral shaft fractures, adding a positional screw could be more stabilizing than bridge plating without a positional screw, leading to faster bony union. A positional screw might help control interfragmentary movement without inhibiting essential interfragmentary movement for fracture healing.
本研究比较了在肱骨干骨折治疗中采用微创钢板接骨术（MIPO）时使用或不使用定位螺钉的临床和影像学结果差异。
2010年1月至2021年1月，对共63例行MIPO技术治疗肱骨干骨折的患者进行回顾性研究。我们将这些患者分为两组：第一组患者行不使用定位螺钉的MIPO；第二组患者行使用定位螺钉的MIPO。我们比较了功能结果，包括美国肩肘外科医师评分、加州大学洛杉矶分校评分、简易肩关节测试、手术前后的活动范围、手术时间、失血量和并发症。并且我们比较了影像学结果，包括术前和术后骨折的前后位（AP）和侧方移位以及X线平片上的愈合时间。
患者平均年龄为64.6±15.1岁（范围25 - 88岁）。第一组由30例患者组成（10例男性和20例女性），第二组由33例患者组成（11例男性和22例女性）。两组之间在性别、体重指数、功能评分、术后X线片上骨折的AP和侧方移位、手术时间和失血量方面无统计学显著差异。在第二组中，获得骨愈合的速度比第一组更快（4.6个月对6.4个月）。并发症包括两组各2例短暂性桡神经麻痹和金属植入物失败（第一组2例，第二组1例）。
在对肱骨干骨折进行MIPO时，添加定位螺钉可能比不使用定位螺钉的桥接钢板更具稳定性，从而导致更快的骨愈合。定位螺钉可能有助于控制骨折块间运动，而不抑制骨折愈合所需的必要骨折块间运动。
