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目的 观察外固定架固定治疗肱骨干骨折的临床疗效，评估骨性-肌性体表标志安全区置钉技术在此类手术中应用价值。方法 回顾性分析自2012-02—2024-08采用外固定架固定治疗的15例肱骨干骨折，术中于骨性-肌性体表标志的安全区置钉，肱骨近端置钉危险区为肩峰与肱骨外上髁连线上1/5处，近端置钉时应避免在三角肌粗隆后侧，可能伤及后侧桡神经沟内的桡神经。肱骨远端置钉危险区为三角肌粗隆至肱桡肌起点之间的外侧部分，系桡神经穿过外侧肌间隔在上臂外侧的走行区域。结果 15例均获得完整随访，随访时间≥12个月。骨折均骨性愈合，愈合时间12～24周，平均16.2周。术后1例出现桡神经损伤症状，不能垂腕、伸拇指，经营养神经、伸腕伸指支具固定及康复训练5个月后恢复正常。术后1例出现轻微针道感染，口服抗生素及加强换药后痊愈。末次随访时肩关节功能Constant-Murley评分为68～90分，平均78.6分；肘关节功能Mayo评分为72～95分，平均82.9分。结论 外固定架固定手术适用于治疗多种类型的肱骨干骨折，可以有效促进骨折愈合及患肢功能恢复，采用骨性-肌性体表标志安全区域置钉技术可以规避术中神经损伤风险，提高了手术安全性。
Abstract：Objective To observe the clinical efficacy of external fixator for humeral shaft fractures and evaluate the application value of the safe zone pinning technique based on osseous and muscular surface landmarks in such procedures.Methods A retrospective analysis was conducted on 15 cases of humeral shaft fractures treated with external fixator from February 2012 to August 2024. Intraoperatively, pins were placed within the safe zone defined by osseous and muscular surface landmarks. The danger zone for proximal pin placement was identified as the proximal one-fifth of the line connecting the acromion and the lateral epicondyle of the humerus; during proximal pin insertion, care should be taken to avoid the posterior aspect of the deltoid tuberosity, as this area may endanger the radial nerve within the radial groove. The danger zone for distal pin placement was the lateral portion between the deltoid tuberosity and the origin of the brachioradialis muscle, corresponding to the course of the radial nerve as it pierces the lateral intermuscular septum in the lateral arm.Results All 15 patients completed follow-up of minimum 12 months. All fractures achieved bony union, with healing time ranging from 12 to 24 weeks(mean, 16.2 weeks).Postoperatively, one patient developed radial nerve injury symptoms, presenting with inability to extend the wrist and thumb;neurological function recovered fully after 5 months of conservative treatment including neurotrophic therapy, wrist and finger extension splinting, and rehabilitation training. One patient experienced mild pin tract infection, which resolved with oral antibiotics and enhanced dressing changes. At the final follow-up, the mean Constant-Murley shoulder score was 78.6 points(range,68-90 points), and the mean Mayo elbow performance score was 82.9 points(range, 72-95 points).Conclusion Application of external fixator is suitable for various types of humeral shaft fractures and can effectively promote fracture healing and functional recovery of the affected limb. The safe zone pinning technique based on osseous and muscular surface landmarks can avoid the risk of intraoperative nerve injury and enhance surgical safety.
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基本信息:
中图分类号:R687.3
引用信息:
[1]李猛,艾进伟,刘铮楷,等.外固定架固定治疗肱骨干骨折疗效观察及骨性-肌性体表标志安全区置钉研究[J].中国骨与关节损伤杂志,2026,41(03):261-265.
2026-03-15
2026-03-15