目的 探讨上臂前侧入路微创钢板接骨术（MIPO）治疗成人肱骨干中下段骨折的临床疗效。 方法 回顾性队列研究。纳入2016年10月—2022年9月南通大学附属常熟医院骨科73例成人肱骨干中下段骨折患者的临床资料，其中男42例、女31例，年龄18~86（53.0±20.4）岁。按照患者手术方式分组：MIPO组39例，采用前侧入路MIPO；切开复位内固定术（ORIF）组34例，采用前外侧入路ORIF。观察指标：比较2组患者的性别、年龄、致伤原因、外伤至手术时间、骨折AO分型等基线资料；比较2组患者手术时间、手术切口长度、术中X线透视次数、术中出血量、术后住院时间、骨折愈合时间，记录手术并发症，采用美国肩肘外科协会评分系统（ASES）分别于术后1周、1个月、3个月、12个月评估患侧上肢肩肘功能。 结果 2组患者的性别、年龄、致伤原因、外伤至手术时间、骨折AO分型等基线资料比较，差异均无统计学意义（P值均>0.05）。2组患者均顺利完成手术，术后随访13~48（29.6±2.3）个月。2组患者的手术时间、术中X线透视次数、骨折愈合时间差异均无统计学意义（P值均>0.05）。MIPO组手术切口长度为（8.4±1.1）cm，短于ORIF组的（13.8±1.9）cm；术中出血量138.0（132.0，167.0）mL，少于ORIF组的248.5（240.8，290.3）mL；术后住院时间4.0（3.0，4.0）d，短于ORIF组的6.0（5.0，7.0）d：差异均有统计学意义（t=-14.37，Z=-7.33、-6.29，P值均<0.001）。与ORIF组相比，MIPO组术后1周、1个月、3个月的ASES评分更高，差异均有统计学意义（t=6.50、4.62、4.67，P值均<0.05）；2组患者术后12个月ASES评分差异无统计学意义（P>0.05）。MIPO组3例术后出现患肘前侧麻木症状，均在术后6周余恢复正常感觉；无切口感染及骨不愈合。ORIF组4例骨折延迟愈合、1例骨折感染性骨不连继发内固定断裂，均予二次手术自体髂骨植骨术后骨折愈合；7例主诉术后患侧手部虎口区麻木症状，观察3月余症状均完全消失。 结论 前侧入路MIPO治疗成人肱骨干中下段骨折，能避免广泛的软组织剥离及桡神经暴露，对骨折断端血供干扰小，临床疗效满意。 Objective This study aimed to explore the clinical outcomes of anterior minimally invasive plate osteosynthesis (MIPO) in the surgical treatment of adult mid-distal humeral diaphyseal fractures. Methods A retrospective cohort study was conducted to analyze 73 patients with adult mid-distal humeral diaphyseal fractures admitted to the Affiliated Changshu Hospital of Nantong University from October 2016 to September 2022. The patients consisted of 42 males and 31 females, aged 18-86 (53.0±20.4) years. They were divided into the MIPO group (n=39) and the anterolateral approach open reduction and internal fixation (ORIF) group (n=34) in accordance with the surgical procedure used. Baseline data, such as gender, age, cause of injury, duration of disease, and fracture AO classification, were compared between the MIPO and ORIF groups. Operative time, scar length, radiation exposure time, intraoperative blood loss, postoperative hospitalization time, bone healing time, and surgical-related complications were recorded and analyzed. The functional status of the shoulder and elbow was evaluated using the American Shoulder and Elbow Surgery (ASES) scoring system at different time points (1 week, 1 month, 3 months, and 1 year after the operation) between the MIPO and ORIF groups. Results All the operations in both groups were successfully performed, and the patients were followed up for 13-48 (29.6±2.3) months. No significant difference was observed in the basic data, such as age, gender, cause of injury, duration of disease, and fracture AO classification between the MIPO and ORIF groups (all P values >0.05). No significant difference was noted in surgical time, radiation exposure time, and bone healing time between the two groups (all P values >0.05). Compared with that in the ORIF group, incision length in the MIPO group was shorter ([8.4±1.1] cm versus [13.8±1.9] cm), intraoperative blood loss was less (138.0 [132.0,167.0] mL versus 248.5 [240.8, 290.3] mL), postoperative hospital stay was shorter (4.0 [3.0, 4.0] days versus 6.0 [5.0, 7.0] days), and the differences were statistically significant ( t=-14.37, Z=-7.33, Z=-6.29 all P values <0.05). The ASES scores of the MIPO group were higher than those of the ORIF group at 1 week, 1 month, and 3 months after surgery, and the differences were statistically significant ( t=6.50, 4.62, 4.67 all P values <0.05). However, no significant difference in ASES scores was observed between the two groups 1 year after surgery ( P >0.05). Three cases experienced numbness on the anterolateral forearm because of an injury to the lateral antebrachial cutaneous nerve. Furthermore, neither infection nor iatrogenic radial nerve palsy was observed in the MIPO group. In the ORIF group, four cases exhibited delayed union and one case suffered from infected nonunion after primary surgical stabilization. All these patients were uneventfully healed with revision surgery of autogenous iliac bone grafting. Seven cases experienced numbness between the thumb and the index finger due to radial nerve injury, and they recovered uneventfully 3 months later. Conclusion The MIPO technique via the anterior approach avoids the need for radial nerve visualization and extensive soft tissue dissection. It contributes to less disruption of the blood supply at the segment level and satisfactory clinical outcome. Therefore, this technique should be considered an attractive alternative for patients who require operative intervention of adult mid-distal humeral diaphyseal fractures.
Clinical efficacy of anterior minimally invasive plate osteosynthesis in the surgical treatment of adult mid-distal humeral diaphyseal fractures
Objective This study aimed to explore the clinical outcomes of anterior minimally invasive plate osteosynthesis (MIPO) in the surgical treatment of adult mid-distal humeral diaphyseal fractures. Methods A retrospective cohort study was conducted to analyze 73 patients with adult mid-distal humeral diaphyseal fractures admitted to the Affiliated Changshu Hospital of Nantong University from October 2016 to September 2022. The patients consisted of 42 males and 31 females, aged 18-86 (53.0±20.4) years. They were divided into the MIPO group (n=39) and the anterolateral approach open reduction and internal fixation (ORIF) group (n=34) in accordance with the surgical procedure used. Baseline data, such as gender, age, cause of injury, duration of disease, and fracture AO classification, were compared between the MIPO and ORIF groups. Operative time, scar length, radiation exposure time, intraoperative blood loss, postoperative hospitalization time, bone healing time, and surgical-related complications were recorded and analyzed. The functional status of the shoulder and elbow was evaluated using the American Shoulder and Elbow Surgery (ASES) scoring system at different time points (1 week, 1 month, 3 months, and 1 year after the operation) between the MIPO and ORIF groups. Results All the operations in both groups were successfully performed, and the patients were followed up for 13-48 (29.6±2.3) months. No significant difference was observed in the basic data, such as age, gender, cause of injury, duration of disease, and fracture AO classification between the MIPO and ORIF groups (all P values >0.05). No significant difference was noted in surgical time, radiation exposure time, and bone healing time between the two groups (all P values >0.05). Compared with that in the ORIF group, incision length in the MIPO group was shorter ([8.4±1.1] cm versus [13.8±1.9] cm), intraoperative blood loss was less (138.0 [132.0,167.0] mL versus 248.5 [240.8, 290.3] mL), postoperative hospital stay was shorter (4.0 [3.0, 4.0] days versus 6.0 [5.0, 7.0] days), and the differences were statistically significant ( t=-14.37, Z=-7.33, Z=-6.29 all P values <0.05). The ASES scores of the MIPO group were higher than those of the ORIF group at 1 week, 1 month, and 3 months after surgery, and the differences were statistically significant ( t=6.50, 4.62, 4.67 all P values <0.05). However, no significant difference in ASES scores was observed between the two groups 1 year after surgery ( P >0.05). Three cases experienced numbness on the anterolateral forearm because of an injury to the lateral antebrachial cutaneous nerve. Furthermore, neither infection nor iatrogenic radial nerve palsy was observed in the MIPO group. In the ORIF group, four cases exhibited delayed union and one case suffered from infected nonunion after primary surgical stabilization. All these patients were uneventfully healed with revision surgery of autogenous iliac bone grafting. Seven cases experienced numbness between the thumb and the index finger due to radial nerve injury, and they recovered uneventfully 3 months later. Conclusion The MIPO technique via the anterior approach avoids the need for radial nerve visualization and extensive soft tissue dissection. It contributes to less disruption of the blood supply at the segment level and satisfactory clinical outcome. Therefore, this technique should be considered an attractive alternative for patients who require operative intervention of adult mid-distal humeral diaphyseal fractures.
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