MIPPO与ORIF治疗NeerⅡ型老年性肱骨外科颈骨折的对比分析

Treatment of type NeerⅡ humeral surgical neck fractures in elderly patients: MIPPO versus ORIF

目的比较经皮微创接骨板内固定术(MIPPO)与切开复位内固定术(ORIF)两种手术方法治疗NeerⅡ型老年性肱骨外科颈骨折的临床疗效。方法选择Neer II型老年性肱骨外科颈骨折患者40例,其中采用经三角肌前外侧1/3入路MIPPO治疗18例(MIPPO组),采用传统胸大肌三角肌入路ORIF治疗22例(ORIF组)。比较两组患者手术切口长度,术后住院时间,术中透视次数,骨折愈合时间,术后1、3、6个月Constant-Murley肩关节评分及并发症发生情况。结果 MIPPO组手术切口长度较ORIF组短,术后住院时间、骨折愈合时间均较ORIF组少,术中透视次数较ORIF组多,术后1、3、6个月肩关节功能评分均较ORIF组高,两组患者比较差异均有统计学意义(均P<0.05)。两组各有1例发生复位丢失,MIPPO组有1例腋神经损伤,ORIF组有2例延迟愈合。两组患者均未发生切口感染、螺钉松动和内固定断裂。结论 MIPPO治疗NeerⅡ型老年性肱骨外科颈骨折具有瘢痕小、恢复快、骨折愈合快、早期肩关节功能恢复好等优点,但有腋神经损伤、术中X线暴露多等缺点。

Objective To compare the clinical efficacy of minimally invasive percutaneous plate osteosynthesis（MIPPO） with open reduction and internal fixation （ORIF） in treatment of senile NEER II humeral surgical neck fractures. Methods Forty patients aged over 65y with Neer II humeral surgical neck fractures were admitted. Among 40 patients, 18 were treated with MIPPO through anterolateral acromial approach and 22 were treated with ORIF through deltopectoral approach. The length of incision, length of postoperative hospital stay, times of fluoroscopy, duration of fracture healing, Constant-Murley score of the shoulder joint 1, 3, 6 monthes after operation and complications were observed and compared between two groups. Results The length of incision, length of postoperative hospital stay, duration of fracture healing in MIPPO group were shorter than those in ORIF group, the times of fluoroscopy in MIPPQ group were more than in ~RIF group, the Constant-Murley score of the shoulder joint 1, 3, 6 months after operation in MIPPO group was higher than in ORIF group （all P〈O.05）. There were one case of fracture redisplacement in each group, one case of axillary nerve injury in MIPPO group, two cases of delayed union in ORIF group. No incision infection, screw loosening or plate break were observed. Conclusion MIPPO technique for the treatment of senile Neer II humeral surgical neck fracture has the advantages of a shorter incision, faster recovery and bone healing, better shoulder function. The disadvantage is more exposure to radiation and the possible axillary nerve injure.