经皮微创钢板内固定术治疗肱骨近端骨折的疗效观察

Percutaneous plate osteosynthesis for treatment of proximal humerus fracture

[目的]总结应用经皮微创与切开复位钢板内固定治疗肱骨近端骨折的临床效果。[方法]对2014年1月~2014年12月手术治疗并获得随访的57例肱骨近端骨折患者进行回顾性分析,其中27例行经皮微创钢板内固定,男9例,女18例;年龄70.5(51.4~89.5)岁,按照Neer分型,二部分骨折14例,三部分骨折11例,四部分骨折2例;30例行切开复位钢板内固定,男11例,女19例,年龄69.5(52.3~86.8)岁,按照Neer分型,二部分骨折13例,三部分骨折14例,四部分骨折3例。从手术相关指标、患侧Neer肩关节功能评分及术后并发症情况3个方面对两种治疗方法进行比较分析。[结果]:57例患者获得随访,时间13~24个月,平均17.8个月。术后出现感染、腋神经损伤、肱骨头坏死各1例,内固定失效3例。经皮微创组手术切口长度、术中出血量、住院天数、骨折愈合时间均优于切口组,两组间差异有统计学意义(P<0.05),而手术时间比较两组差异无统计学意义(P>0.05)。术后并发症的发生率两组比较差异无统计学意义(P>0.05),术后12个月的肩关节功能Neer评分两组比较差异无统计学意义(P>0.05)。[结论]:经皮微创钢板内固定治疗肱骨近端骨折具有创伤小、骨折愈合快等特点。

[ Objective] To investigate the clinical outcomes of minimally invasive percutaneous plate osteosynthesis （MIPPO） versus open reduction and internal fixation （ORIF） in the treatment of proximal humerus fracture. [Methods ] We retrospectively analyzed 57 patients with proximal humerus fracture who were followed up after their surgeries from January to December,2014. Among these patients,27 （9 males and 18 females） with a mean age of 70.5 （51.4 and 89.5 for males and females, respectively） were treated with MIPPO, and based on the Neer classification, there were 14,11,and 2 cases with two, three, and four-part fractures of proximal humerus,respectively. The remaining 30 cases （ 11 males and 19 females） with a mean age of 69.5 （52.3 and 86.8 for males and females, respectively） were treated with ORIF, and there were 13,14,and 3 cases with two,three,and four-part fractures of the proximal humerus, respectively. We compared the operation-related indices, postoperative complications, and patients＇ shoulder functions assessed by Neer score after surgery. [Results] Fifty-seven pa- tients were followed up for 13 to 24 months （mean 17.8 months） . Infection,axillary nerve paralysis,and avascular necrosis of the humeral head was each identified in 1 case, and 3 cases had ineffective internal plate fixation post-operatively. The MIPPO group had shorter incision length （P〈0.05） , less blood loss （P〈0.05） , shorter hospital stay （P〈0.05） , and faster fracture healing （P〈0.05） compared with the ORIF group. There was no difference in the operation time, the incidence of postoperational complication, or the Neer score of shoulder function at 12 months after surgery between the two groups （P 〉0.05） . [Conclusions] MIPPO generates small invasion and faster facture healing.