经皮微创接骨板固定术治疗青壮年肱骨近端Neer三部分骨折

Minimally invasive percutaneous plate osteosynthesis for Neer three-part fractures of proximal humerus in young adults

目的探讨经皮微创接骨板固定术（MIPPO）治疗青壮年肱骨近端Neer三部分骨折的近期疗效。方法回顾性分析2010年3月至2016年12月期间收治且获得随访的46例年龄〈65岁的肱骨近端Neer三部分骨折患者资料。根据是否采用MIPPO分为2组：MIPPO组23例，男12例，女11例：平均年龄为（41．6±1．2）岁；采用MIPPO肱骨近端锁定接骨板（LPHP）固定。对照组23例，男14例，女9例；平均年龄为（42．2±1．6）岁；采用切开复位LPHP固定。比较两组患者的手术时间、术中出血量、骨折愈合时间及末次随访时肩关节Neer评分等。结果MIPPO组和对照组患者的随访时间平均分别为（13．4±1．2）、（14．2±2．4）个月，差异无统计学意义（P〉0．05）。MIPPO组患者的手术时间【（105±15）min】显著短于对照组患者[（120±20）min]，术中出血量[（140±50）mL]显著少于对照组患者[（320±40）mL]，骨折愈合时间[4．2±0．6）个月]显著短于对照组患者[（5．4±1．2）个月]，末次随访时肩关节Neer评分[（88．6±3．4）分]显著高于对照组患者[（81．6±2．2）分]，差异均有统计学意义（P〈0．05）。MIPPO组和对照组患者的术后并发症发生率分别为4．3％（1／23）、17．4％（4／23），差异无统计学意义（P〉0．05）。结论MIPPOLPHP固定治疗青壮年肱骨近端Neer三部分骨折在手术创伤以及肩关节功能恢复方面较切开复位LPHP固定有明显优势。

Objective To evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis （MIPPO） in the treatment of Neer three-part fractures of the proximal humerus in young adults. Methods A retrospective analysis was performed of the 46 patients aged 〈 65 years with Neer three-part fracture of the proximal humerus from March 2010 to December 2016. MIPPO with locking proximal humerus plate （LPHP） was used in 23 of them who were 12 men and 11 women with an average age of 41.6 ± 1.2 years; open reduction and internal fixation （ORIF） with LPHP was used in the other 23 patients who were 14 men and 9 women with an average age of 42.2 ± 1.6 years. The 2 groups were compared in terms of operation time, intraoperative bleed- ing, fracture healing time and shoulder function by Neer scoring at the last follow-up. Results The average follow-up （13.4 ± 1.2 months） for the MIPPO groups was not statistically different from that for the ORIF group （ 14.2 ± 2.4 months） （ P 〉 0.05） . The MIPPO group reported significantly shorter operation time （ 105 ± 15 min）, significantly less intraoperative bleeding （140 ± 50 mL）, significantly shorter fracture healing time（4.2 ± 0.6 months）, and significantly higher shoulder Neer scores （88.6 ± 3.4） than the ORIF group （120 ± 20 min, 320 ±40 mL, 5.4 ± 1.2 months, and 81.6 ± 2.2, respectively） （ P 〈 0. 05）. The complication rate（4.3%, 1/23 ） for the MIPPO group was not significantly different from that for the ORIF group （17.4%, 4/23） （ P 〉 0. 05） . Conclusion MIPPO with LPHP may be obviously advantageous over ORIF with LPHP in the treatment of proximal humeral fractures in young adults.