正骨手法结合MIPPO技术重建内侧柱稳定治疗老年骨质疏松性肱骨近端骨折的对照研究

Comparative Study of Bone Setting Manipulation Combined with MIPPO Technology to Rebuild the Stability of the Inner Column for the Treatment of Osteoporotic Proximal Humeral Fractures in the Elderly

目的:探讨正骨手法闭合复位结合经皮微创固定(MIPPO)治疗老年肱骨近端骨折的临床疗效。方法:选取老年肱骨近端骨折40例随机分为正骨手法+MIPPO技术固定组(简称手法组)和传统切复内固定组(简称切复组),每组20例,分别进行治疗。术后3、6、12个月,观察恢复情况:骨折恢复、内固定松动断裂、肱骨头缺血坏死、内固定取出时间和内固定取出后局部骨质等情况,及有无再骨折,并采用Constant-Murley评分系统对肩关节功能进行评分。结果:40例患者均获随访,手法组1例患者术后出现肱骨头内翻畸形,骨折畸形愈合,1例患者出现肱骨头缺血性坏死;切复组2例患者出现肱骨头内翻。两组术后肩关节功能Constant-Murley评分比较,差异有统计学意义(P<0.05)。结论:正骨手法闭合复位结合经皮微创固定治疗老年肱骨近端骨折,重建内侧柱稳定,具有创伤小、血循破坏少、固定可靠等优点,是治疗老年性肱骨近端骨折的有效方法。

Objective： To investigate the clinical effects of bone setting manipulation combined with minimally invasive percutaneous plate osteosynthesis （MIPPO） reconstruction technique for the treatment of osteoporotic proximal humeral fractures in the elderly. Methods：40 elder patients of osteoporotic proximal humeral fractures were randomly divided into Bone setting technique plus MIPPO fixation group （manipulation group） and traditional cutting in fixation group （cut complex group）, with 20 cases in each, treated respectively. 3, 6, 12 months after the operation, observed the recovery situation, including fracture restoration, internal fixation loosening or fracture, ischemic necrosis of humeral head, internal fixation time, local bone condition after internal fixation and re-fracture. And the function of shoulder joint was evaluated by Constant-Murley scoring system. Results： 40 patients were followed up. In the manipulation group, one case appeared varus deformity of the caput humeri and malunion, another case appeared avascular necrosis of the humeral head; while in the cut complex group, two case appeared humeral varus. In comparison, the differences of the postoperative shoulder function＇ s Constant-Murley scores between the two groups was statistically significant （/＇〈0.05）. Conclusion： Use bone setting manipulation combined with MIPPO reconstruction technique to treat the osteoporotic proximal humeral fractures in the elderly has the advantages of reconstructing the columnae medialis stably, less trauma, less blood circulation and reliable fixation and so on. It is an effective method for the treatment of osteoporotic proximal humeral fractures in the elderly.