经皮微创锁定钢板内固定术与传统切开复位内固定术治疗肱骨近段粉碎性骨折疗效比较

Minimally invasive percutaneous plate osteosynthesis versus open reduction and internal fixation in treatment of proximal humeral comminuted fracture

目的比较经皮微创锁定钢板内固定术(MIPPO)和传统AO切开复位普通钢板内固定术(ORIF)治疗肱骨近段粉碎性骨折的临床效果。方法对肱骨近段粉碎性骨折用MIPPO技术治疗24例、传统ORIF治疗20例,对两组的临床效果进行比较。结果MIPPO组有2例术中进行骨移植术;术后随访20～48(25.3±3.4)个月,均获骨性愈合,骨折愈合时间12～20(14.83±3.83)周;3例有5°以上的轻度内外翻畸形;按Neer功能评分:优13例,良8例。ORIF组有9例进行骨移植术;随访20～48(21.2±3.1)个月,3例出现肱骨头坏死,余患者均获得骨性愈合,骨折愈合时间16～32(24.24±4.88)周;2例发生5°的外翻畸形,1例出现螺钉松动;Neer功能评分:优5例,良7例。两组均无感染和内固定断裂等并发症发生。两组在骨折愈合时间和功能恢复方面比较,差异有统计学意义(P<0.05)。结论用MIPPO技术治疗肱骨近段粉碎性骨折可以降低植骨需求,在骨折愈合及术后功能恢复方面有明显优势。

Objective To comparatively analyze the clinical results of minimally invasive percutaneous plate osteosynthesis（MIPPO） and open reduction and internal fixation（ORIF） in the treatment of proximal humeral comminuted fracture.Methods 24 cases with proximal humeral comminuted fracture were treated with locking proximal humeral plate by MIPPO,and 20 cases with common plate by ORIF.The results were compared.Results In MIPPO group,2 cases were performed bone grafting.24 cases were followed up for 20~48 months（mean 25.3±3.4）.All cases gained bone union with an average of 14.83±3.83 weeks.Inversion or extroversion deformity appeared in two cases with less than 5 degrees.According to Neer scoring,the results were excellent in 13 and good in 8.In ORIF group,9 cases were performed bone grafting.20 cases were followed up for 20~ 48 months（mean 21.2±3.1）.Necrosis of humeral head happened in 3 cases,the others gained bone union in 16~32 weeks with an average of 24.24±4.88 weeks.Inversion or extroversion deformity appeared in three cases with less than 5 degrees.According to Neer scoring,the results were excellent in 5 and good in 7.Screw loosing happened in 1,and there was no infection,no breakage of nails of the internal fixations in all the cases.There were significant differences in statistics between the two groups in bone union time and Neer joint function scoring（P0.05）.Conclusions MIPPO associated with locking proximal humeral plate can reduce bone grafting in operation,which have obvious advantages in bone union and function recovery after operation for proximal humeral comminuted fracture.