应用微创技术锁定钢板固定技术治疗老年肱骨近端不稳定型骨折的疗效观察

Clinical observation of minimally invasive percutaneous plate osteosynthesis in the treatment of senile unstable proximal humeral fractures

目的探讨应用微创接骨板内固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗老年肱骨近端不稳定型骨折的临床疗效。方法选取2015年7月至2017年8月本院采用微创接骨板内固定技术手术治疗并成功随访的34例肱骨近端不稳定型骨折老年患者,其中男12例,女22例;年龄69.2~81.5岁,平均年龄为73.5岁;右侧20例,左侧14例。骨折按Neer分型:二、三、四部分骨折分别为10例、17例、7例。受伤到手术时间3~7 d,本组患者均获得完整随访资料,分别记录手术时间、手术出血量、术中透视次数、骨折愈合时间、术后并发症发生率及术后12个月时肩关节功能Neer评分分析该手术方法的临床疗效。结果所有患者均获随访,随访时间12~18个月,平均16个月。手术时间52.6~135.4 min,平均78.5 min;术中出血量45.6~135.4 mL,平均75 mL;术中透视7~18次,平均9.7次;骨折愈合时间2.3~5个月,平均愈合时间3个月。2例出现内固定松动,经治疗后骨折均一期愈合。术后12个月时肩关节功能Neer评分:优22例,良8例,可3例,差1例,总体优良率88.2%。结论微创接骨板内固定技术是治疗肱骨近端骨折的有效方法,创伤小、骨折愈合快,临床疗效满意。

Objective To explore the efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)for the treatment of unstable proximal humeral fractures in elderly patients.Methods A total of 34 elderly patients with unstable proximal humeral fractures who were treated by MIPPO in our hospital from July 2015 to August 2017 were selected.There were 12 males and 22 females,with an average age of 73.5(69.2-81.5)years.Among them,20 cases were right shoulder,and 14 cases were left shoulder.According to Neer fractures classification,there were 10 cases of two parts fractures,17 cases of three parts fractures,7 cases of four parts fractures.The operation time,fracture healing time,postoperative complications and shoulder joint Neer scores at 12 months after surgery were recorded.Results All patients were followed up for an average of 16 months(12 to 18 months).The average operation time was 78.5 min(52.6-135.4 min),the average blood loss in operation were 75 mL(45.6-135.4 m L),the average X-ray exposure were 9.7 times(7-18 times),and the average fracture healing time was 3 months(2.3-5 months).In addition,2 cases had internal fixation loosen.All fractures were healed after treatment.At the 12 months’follow-up after surgery,according to Neer score of shoulder joint,there were 22 cases with excellent,8 good,3 fair,1 poor,and the excellent and good was 88.2%(30/34).Conclusion Minimally invasive percutaneous plate osteosynthesis is an effective method for the treatment of proximal humeral fractures.