MIPO术结合锁定钢板对肱骨近端粉碎性骨折的临床疗效

Efficacy of MIPO technology combined with locking plate on treatment of comminuted fracture of proximal humerus

目的探讨微创钢板固定术(MIPO)结合锁定钢板对肱骨近端粉碎性骨折的临床疗效。方法选取80例肱骨近端粉碎性骨折患者,按照入院时间段分为两组,对照组(39例)给予传统钢板内固定治疗,MIPO组(41例)给予MIPO联合锁定钢板治疗。观察并记录两组围手术期指标、肩功恢复情况、SF-36量表评分及随访12个月期间并发症发生情况。结果 MIPO组在术中失血量、手术时间和骨折愈合时间上均明显少于对照组(P<0.05),两组住院时间没有统计学差异(P>0.05);术后6个月,MIPO组肩功能恢复优良率明显高于对照组(P<0.05);与术前相比,术后6个月两组SF-36量表各项评分均明显升高,而两组间比较,没有统计学差异(P>0.05);随访12个月期间,两组并发症如延迟愈合、不愈合、畸形愈合、桡神经损伤、术后感染等的发生率均较低,两组相比,没有统计学差异(P>0.05)。结论 MIPO结合锁定钢板对肱骨近端粉碎性骨折具有骨折愈合快、恢复肩关节功能好、改善患者生活质量、手术安全等优点,值得临床推广。

Objective To explore the efficacy of minimally invasive plate fixation （MIPO） combined with locking plate on treatment of comminuted fracture of proximal humerus. Methods A total of 80 patients with comminuted fracture of proximal humerus were selected and divided by the admission time into two groups： the control group （n=39） treated with traditional internal fixation of steel plate and the MIPO group（n= 41） treated with MIPO combined with locking plate. The perioperative indicators, shoulder function recovery, SF-36 scale scores and the incidence of complication during the 12-month follow-up visit in the two groups were observed and recorded. Results The intraoperative blood loss, operation time and fracture healing time in the MIPO group was much less or shorter than those in the control group （P 〈 0.05）. There was no statistical difference in the LOS between two groups （P 〉 0.05）. Six months after the operation, the excellent rate of shoulder function recovery in the MIPO group was significantly higher than that in the control group （P 〈 0.05）; six months after the operation, the scores of SF-36 of two groups were significantly higher than those before the operation, but there was no statistical difference between the two groups （P 〉 0.05）. During the 12-month follow-up visit, the incidence of such complications as delayed union, nonunion, malunion, radial nerve injury and postoperative infection was low. There was no statistical difference in such incidence between the two groups （P 〉 0.05）. Conclusion To sum up, MIPO combined with locking plate can promote fracture union, restore the function of the shoulder, improve the quality of life and reduce the complication rate of nonunion and infection rate. It was worthy of clinical popularization.