手术-肱骨干骨折桥接钢板内固定术

1.1、原则桥接钢板Bridge plating uses the plate as an extramedullary splint, fixed to the two main fragments, while the intermediate fracture zone is left untouched. Anatomical reduction of the shaft fragments is not necessary. Furthermore, direct manipulation risks disturbing their blood supply. If the soft tissue attachments are preserved, and the fragments are relatively well aligned, healing is predictable.桥接钢板把钢板作为髓外夹板，固定两个主要骨折端，而骨折区域不予干预，肱骨干骨折不必解剖复位，并且，直接操作复位有干扰骨折端血供的风险，如果保留软组织的连续，骨折愈合可能性增加。

Alignment of the main shaft fragments can usually be achieved indirectly utilizing traction and soft tissue tension.主要骨折块的对位对线可以通过间接使用牵开器和软组织附着性来完成。

Mechanical stability, provided by the bridging plate, is adequate for indirect healing (callus formation). Occasionally, a larger wedge fragment might be approximated to the main fragments with a lag screw. Lag screws should be avoided when there are multiple fragments桥接钢板提供稳定性，对于骨折二期愈合（骨痂愈合）是充足的，个别情况下，一个大的楔形骨折需要用拉力螺钉固定到主要骨折块，在多段骨折情况下避免使用拉力螺钉。

1.2 桥接钢板的置入 Bridge plate insertionBridge plates can be inserted either with an open exposure, or through a minimally invasive (MIO) approach, which leaves soft tissues intact over the fracture site. The latter requires fluoroscopic monitoring. With open bridge plating, it is important to preserve soft-tissue attachments to the fracture fragments. To do this, stable provisional reduction (with external fixation, large distractor, or maintained manual traction), and minimal exposure and manipulation of the fracture zone are important. The bridge plate is applied through an incision just wide enough for the plate.桥接钢板可以通过切开显露，或通过微创显露置入，在MIO情况下可以保留骨折区域软组织完整性，但其要求术中透视帮助。

桥接钢板技术，保留骨折断端软组织连续性是很重要的，为了做到这个，稳定的临时复位（通过外固定架，大的牵开器，持骨器），最小程度显露和操作骨折区域是很重要的，桥接钢板需要手术切口可以置入钢板即可。

1.3 复位 ReductionIt is important to restore axial alignment and rotation. A little shortening of 1 or 2 cm can be accepted in the humerus, and in complex multifragmentary fractures may improve bone contact.Exceptionally, a large fragment has been separated from the fracture with a sharp end impaled in the adjacent muscle. This may need to be repositioned directly with protection of soft-tissue attachments.复位骨折轴向序列和旋转移位是重要的，短缩1-2cm是可以接受的，在复杂多段骨折可以提供骨的接触。

另外一些情况，大骨折块从骨折断端分离插入临近的肌肉组织，此中情况需要直接复位骨折，同时注意保护软组织连续性。

2.1 钢板的位置 Plate locationThe humerus has an anterolateral, a posterior, and a medial surface to each of which a plate can be applied. The location of the fracture will determine where the surgeon chooses to apply a plate to the humerus. The position of the plate is selected according to fracture location, and the length of proximal and distal main segments.肱骨有前外侧面，后面，内侧面，三面都可以应用钢板。

钢板的位置通过骨折位置以及位置。

The location should allow sufficient plate length on both proximal and distal segments, with a minimum of 4 holes for each.钢板在骨折的主要骨折端最少需要4孔长度An anterolateral plate fits well from very proximally to the distal fifth of the humerus.肱骨前外侧可以适合从肱骨最近端到远端1/5的区域。

The posterior surface is difficult to access proximally and is best suited for middle and distal third fractures. Once a location for the plate has been selected, the surgical approach is determined by that location. For proximal fractures, an anterolateral plate location and anterolateral surgical exposure are usual. For distal fractures, a posterior plate location is preferred. This area can be accessed with either a posterolateral, or a posterior, approach. In the central portion of the humerus, the plate can be applied to the anterolateral, lateral, or posterior surfaces, with the approach dependent on the preferred plate location.肱骨后面显露近端较困难，更适合中段和远1/3骨折，当内置物选择完成后，手术切口由骨折位置决定，对于近端骨折，可以前外侧显露和前外侧置入钢板。

对于远端骨折，后侧钢板置入更合适，此区域可以通过后外侧或后侧切口进入。

在肱骨干中段，钢板可以放置在前外侧或外侧，或后侧，切口根据钢板放置位置决定。

The medial surface is generally reserved for complex reconstructive procedures. 内侧面通常为复杂骨折重建应用。

2.2 外侧置入 Lateral platingAn anterolateral approach is chosen for proximal and middle third fractures, and allows supine patient positioning.The lateral approach can also be used, particularly if the most proximal part of the humerus need not be exposed.Distally, the plate may lie deep to the radial nerve.前外侧切口可以用来显露肱骨近端和中1/3骨折，病人仰卧位，如果肱骨近端不需要显露，外侧切口也可以。

在肱骨远端，肱骨位于桡神经深面。

2.3 后方置入 Posterior platingA posterior approach will generally be chosen for more distal fractures.It is important to protect the radial nerve and its accompanying vessels in the spiral groove. Typically, a posterior plate must be placed underneath the radial nerve, to gain proximal bone anchorage.后方入路通常用于肱骨远端骨折。