中文摘要：

目的探讨采用微创经皮钢板内固定（minimally invasive percutaneous plate osteosynthesis,MIPPO）技术经前侧手术入路预旋转塑形锁定板钉治疗肱骨干中段B型和C型骨折的临床疗效。方法 2012年1月至2015年12月,北京大学人民医院应用MIPPO技术前侧入路预旋转塑形锁定板钉治疗肱骨干中段B型、C型骨折患者16例,其中男6例,女10例;年龄43~70岁,平均（55.8±9.1）岁;根据AO分型：B型11例,C型5例;所有患者均为闭合性骨折,不伴随桡神经损伤。患者行骨折远、近端上臂前方小切口,透视下闭合复位骨折,并于肱骨前方肱骨表面放置预旋转处理的锁定加压钢板（locking compression plate,LCP）桥接固定,LCP近端放置在肱骨外侧,远端放置在肱骨前侧。记录手术时间、术后并发症、骨折愈合时间、肩关节及肘关节活动范围。肩关节功能采用美国加州大学洛杉矶分校（University of California,Los Angeles,UCLA）评分评价,肘关节功能采用Mayo评分评价。结果 16例患者均获得了8~24个月随访,平均（16.13±4.54）个月,手术时间45~120min,平均（70.5±18.5）min。16例患者中有1例出现术中的医源性桡神经损伤,经营养神经药物和电刺激的治疗,术后1个月时腕关节和拇指的背伸功能完全恢复。16例患者骨折愈合时间10~21周,平均（13.5±3.0）周。肩关节外展105~120°,平均（112.5±4.6）°;前屈150~170°,平均（165.4±6.0）°。肘关节伸直0~8°,平均（4.8±2.0）°;屈曲120~140°,平均（132.5±5.8）°。肩关节功能依据UCLA评分标准：优15例,良1例。肘关节功能依据Mayo评分标准：优14例,良2例。结论应用MIPPO技术前侧手术入路预旋转塑形锁定加压板钉治疗肱骨干中段B型和C型骨折临床疗效较好,手术操作方便,骨折断端血运影响小,恢复快,值得进一步临床推广。

英文摘要：

Background Humeral shaft fractures are common,accounting for 2% of the total cases.In recent years,the treatment of humeral shaft fracture has been developed from traditional conservative plaster fixation to plate-screw and intramedullary nail fixation.The application of plate screw for open reduction and internal fixation or closed reduction intramedullary nail fixation has become the golden standard for surgical treatment of humeral shaft fractures.The treatment of humeral shaft fracture with open reduction and internal plate fixation requires the stripping of soft tissuesand muscles.This operation interferes with the blood supply of fracture ends and increases the risk of radial nerve injury.With the renewal of biological fixation theory of AO,indirect reduction technique which emphasizes the protection of soft tissue around fracture has been thrived.It has been reported repeatedly in nation that humeral shaft fracture can be treat with percutaneous plate fixation through minimally invasive percutaneous osteosynthesis,a strategy that results in high curing speed and less complication.Because of the specific anatomical structure of the humeral shaft,it is difficult to put a plate in front of the anterior longitudinal ridge.While the plate placed on the anterolateral side usually interferes with the radial nerve,the plate placed on the anteromedial side of the shaft also interferes with the neurovascular bundle.When the humeral fracture line is high,the corresponding proximal plate placement will affect the function of the shoulder joint.To treat the humeral shaft fracture with open reduction and plate fixation,the ideal position of the plate placement may be the lateral side of the humeral shaft when the plate is proximal to humeral fracture and the front side of the humeral shaft whenthe plate isdistal to humeral fracture.Therefore,the pre-rotating moulding locking plate become a possible solution for the treatment of humeral shaft fracture.From January 2012 to December 2015,16 cases of humeral shaft type B an