两种手术方法治疗老年人肱骨近端骨折的比较研究

Two Surgical Treatments of Humeral Proximal Fractures in the Elderly Patients

目的：探讨采用经皮微创接骨板技术（MIPPO）及切开内固定术（ORIF）治疗老年人肱骨近端骨折的疗效。方法：对78例老年性肱骨近端骨折患者,随机分为两组,即MIPPO组及ORIF组,每组均为39例,分别予MIPPO结合肱骨近端锁定接骨板（LPHP）和切开复位肱骨近端锁定接骨板治疗。对比二者术前、术中情况、骨折愈合情况、并发症及功能恢复情况。结果：所有患者获得9~24个月（平均13.5个月）随访。MIPPO组及ORIF组的切口平均长度分别为（6.5±0.9）cm、（13.8±0.8）cm;术中平均出血量分别为（95.7±11.2）ml、（287.3±38.8）ml;手术时间平均分别为（78.1±12.8）min、（121.5±14.3）min;骨折愈合时间平均分别为（11.4±1.2）周、（12.2±1.4）周。MIPPO组均明显优于ORIF组,差异有统计学意义（P〈0.01）。MIPPO组的术后并发症发生率、术后功能恢复优良率分别为7.7%、79.5%,明显优于ORIF组的30.7%、56.4%,差异有统计学意义（P〈0.01和P〈0.05）。结论：采用MIPPO技术治疗老年肱骨近端骨折,疗效确切,并发症少,术后功能恢复好,值得临床肯定与推广。

Objective：To compare open reduction and internal fixation（ORIF） and minimally invasive percutaneous plate osteosynthesis （MIPPO） in treatment of humeral proximal fractures in the elderly patients. Methods：78 cases of patients with humeral fracture treated randomly by different methods, of which 39 cases of MIPPO, ORIF of 39 cases. The preoperative conditions, fracture healing, Complic-ations and functional recovery were compared between the two methods. Results：All the 78 patients were followed up for 9 to 24 months （average, 13.5 months）. The mean incision length was （6.5±0.9）cm in group MIPPO, （13.8±0.8）cm in group ORIF;the mean operative blood loss was （95.7±11.2）ml in group MIPPO, （287.3±38.8）ml in group ORIF;the mean operative time and the fracture healing time were （78.1±12.8）min and （11.4±1.2）weeks in group MIPPO, （121.5±14.3）min and （12.2±1.4）weeks in group ORIF. There were significant differences between the 2 methods（P〈0.01）. There were significant differences in the occurring rate of complications and functional recovery between the two groups（P〈0.01 and P〈0.05）.Conclusion：LPHP combined with MIPPO techniques is a satisfactory and effective method for treatment of proximal humeral osteoporotic fractures.