微创锁定接骨板与传统切开复位内固定术治疗肱骨近端骨折的临床疗效研究

Clinical effect of minimal invasion locking plate and traditional open reduction internal fixation for terating proximal humeral fracture

目的比较微创锁定接骨板(MIPO)与传统切开复位内固定术(ORIF)治疗肱骨近端骨折的疗效。方法收集2011年2月至2013年1月接受手术治疗的65例肱骨近端骨折患者的临床资料,根据手术方式将患者分为MIPO组(26例)和ORIF组(39例)。比较两组患者手术和住院情况,术后通过电话和门诊的方式对患者进行随访。采用Neer评分和欧洲五维健康量表(EQ-5D)评估患者肩关节功能和生活质量,采用视觉疼痛模拟评分(VAS)评估患者疼痛程度。结果与ORIF组相比,MIPO组手术时间短、出血少、住院时间短,但两组并发症发生率差异无统计学意义(P>0.05)。所有患者术后均完成3年以上的随访,平均随访时间(47.2±6.1)个月。末次随访时MIPO组和ORIF组患者肩关节功能评分为(84.1±9.3)、(82.8±11.5)分,生活质量评分为(0.91±0.09)、(0.89±0.10)分,VAS评分为(0.9±0.8)、(1.2±0.7)分,两组患者各项评分差异均无统计学意义(P>0.05)。结论 MIPO与ORIF治疗肱骨近端骨折均可取得良好的临床疗效,MIPO技术具有创伤小、恢复快等特点。

Objective To compare the clinical effect of minimally invasive plate osteosynthesis （MIPO） and open reduction internal fixation（ORIF）for treating proximal humeral fractures. Methods The clinical data of 65 patients with proximal humeral fractures treated by surgery from February 2011 to January 2013 were collected. The patients were divided into MIPO group （26 cases） and ORIF group （39 cases） according to the surgery mode. The situation of operation and hospitalization was compared between the two groups. The patients were followed up by clinic and telephone modes. The Neer scores and EuroQol 5 dimensions scores （EQ-5D） were adopted to evaluate the function of shoulder joint and quality of life after discharge. The visual analogue scale （VAS） was adopted to evaluate the pain degree. Results Compared with the ORIF group, the MIPO group had less intraoperative bleeding,short operation time and hospital duration, while the incidence rate of complications showed no statistically significant difference between the two groups （P〉0.05）. All cases in both groups were followed up for more than 3 years and the mean follow-up period was （47.2±6.1） months. The shoulder joint function scores at last follow up in the MIPO group and ORIF group were （84.1±9.3） points and （82.8±11.5） points,the living quality scores were （0.91±0.09） points and （0.89±0.10） points and the VAS scores were （0.9±0.8） points and （1.2±0.7） points respectively. The scores of various items showed no statistically significant difference （P〉0.05）. Conclusion Both MIPO and ORIF obtain the good clinical effect in treating proximal humeral fracture,and the MIPO technique has the advantages of small trauma and rapid recovery.