经皮微创新型锁定钢板治疗老年肱骨近端骨折的病例对照研究

Case-control study on minimally invasive percutaneous new plate osteosynthesis applied in proximal humerus fractures in elder patients

目的:评价经皮微创新型锁定钢板内固定治疗老年性肱骨近端3、4部分骨折的临床意义。方法:2008年6月至2010年12月,采用锁定钢板内固定治疗老年肱骨近端3、4部分骨折98例,男43例,女55例;年龄65～84岁,平均(71.3±6.2)岁。47例采取经三角肌外侧入路,经皮微创新型肱骨近端锁定钢板内固定治疗(MIPPO组);51例采取三角肌胸大肌间隙入路,切开复位锁定钢板内固定治疗(ORIF组)。记录患者的手术时间、术中出血量、伤口并发症、住院时间。术后应用Constant评分系统对肩关节进行功能评定。结果:96例患者均获随访,时间13～42个月,平均18.1个月,2例患者随访期内死亡。MIPPO组较ORIF组平均出血量减少125ml(P<0.05)。手术时间两组比较差异无统计学意义。平均住院时间MIPPO组较ORIF组缩短5.1d(P<0.05)。两组患者骨折愈合时间比较差异无统计学意义。末次随访肩关节功能Constant评分两组比较差异无统计学意义,但并发症发生率MIPPO组低于ORIF组(P<0.05)。结论:经皮微创肱骨近端新型锁定钢板内固定具有术中出血少、术后患者恢复快和血运破坏少、并发症发生率低等优点,是治疗老年肱骨近端3、4部分骨折有效的方法。

Objective：To evaluate the clinical significance of minimally invasive percutaneous new plate osteosynthesis （MIPPO） applied in three and four-part fractures of proximal humerus in elder patients. Methods：From June 2008 to December 2010,98 old patients with three and fourart fractures of proximal humerus were treated with locking plate osteosynthesis. There were 43 males and 55 females with an average age of （71.3 ± 6.2） years ranging from 65 to 84. Among them,47 cases were treated with minimally invasive percutaneous new plate osteosynthesis （MIPPO） through antrolateral transdeohoid approach, and meanwhile 51 cases were treated with open reduction and internal fixation （ORIF） through a traditional deltopectoral approach. The operation time ,blood loss ,wound complications and hospital stay were recorded. The functional outcomes of the shoulder were assessed according to Constant score. Results： Ninety-six patients were followed up for 13 to 42 months （averaged 18.1 months）,and 2 patients died during the follow-up period. The mean blood loss of the MIPPO group was lower than that of the ORIF group by 125 ml （P〈O.05）. There was no difference in the operation time between two groups. But the MIPPO group had a slightly shorter hospital stay than the ORIF group （P〈0.05）. All the fractures united clinically and radiologically. The difference of the mean healing time between two groups was not significant. Tile mean Constant score at final follow-up of two groups had no statistic difference. But the rate of complication of the MIPPO group was lower than that of the ORIF group （P〈0.05）. Only 1 case of the MIPPO group had axillary nerve paralysis post-operatively, but 4 cases had slack internal fixation and 2 cases had avascular necrosis of the humeral head in the ORIF group. Conclusion： The technique of percutaneous insertion combined new locking plate internal fixation has the advantages of less blood loss ,rapid recovery ,less vascular damage, lower risk of complications and so on. It can effectively treat the proximal humerus three-and four-part fractures, especially to elder patients with osteoporosis.