经皮微创接骨板内固定术治疗复杂肱骨近端骨折的优势分析

Advantages of percutaneous minimally invasive plate internal fixation in the treatment of complex proximal humeral fractures

目的探究经皮微创接骨板内固定术(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗肱骨近端Neer III、IV部分骨折的临床优势。方法回顾性分析自2015年5月至2018年5月我院分别采用MIPPO与ORIF手术治疗肱骨近端Neer HI、IV部分骨折患者78例。MIPPO组36例,男20例,女16例,其中DI部分骨折21例,IV部分骨折15例;0RIF组42例,男24例,女18例,其中HI部分骨折26例,IV部分骨折16例。比较术中切口长度、出血量、手术时间、骨折愈合时间,术前及术后3、6个月肩关节UCLA评分,术后3、6、12个月肩关节功能Constant-Murley评分,末次随访关节功能分级及腋神经损伤等并发症情况,骨折愈合后对MIPPO组进行肩关节功能评估。结果78例患者均获得随访,时间(17.3±2.8)个月。MIPPO组手术切口长度、骨折愈合时间、术中出血量均明显少于ORIF组。MIPPO组术后3、6个月肩关节UCLA评分29.04±1.63和30.95±1.69均高于ORIF组22.11±2.33和25.96±2.01。MIPPO组术后3、6个月肩关节功能Constant-Murley评分55.64±2.83和75.01±5.71均高于ORIF组45.03±6.32和64.61±6.77o但两组术后12个月肩关节功能Constant-Murley评分及末次肩关节功能分级差异均无统计学意义。骨折愈合后进一步评估MIPPO组肩关节功能:屈曲角度平均为170.5°(161°~180°),外旋角度平均为71。(63.5°-83.5°),内旋角度平均为73.6。(68°~79°),活动度恢复均良好。MIPPO组的并发症发生率为5.56%,优于ORIF组的11.90%(P<0.05)。结论MIPPO与ORIF均能治疗肱骨近端HI部分和IV部分骨折,前者相比于后者在术中切口长度、出血量、骨折愈合时间、3和6个月肩关节功能恢复、并发症等方面具有优越性,值得临床推广。

Objective To explore the clinical advantages of minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of proximal humerus fractures of Neer type ID and IV.Methods From May 2015 to May 201&78 cases of proximal humerus fractures of Neer type H and IV were treated with MIPPO and open reduction and internal fixation(ORIF).There were 36 cases in MIPPO group,20 males and 16 females,including 21 cases of Part HI fractures and 15 cases of Part IV fractures;and 42 cases in ORIF group,24 males and 18 females,including 26 cases of Part ID fractures and 16 cases of Part IV fractures.The length of incision,the amount of bleeding,the time of operation,the time of fracture healing,the UCLA score of shoulder joint before and 3,6 months after operation,the Constant-Murley score of shoulder joint function at 3,6,12 months after operation,the classification of joint function at the last follow-up,the axillary nerve injury and other complications were compared.The shoulder joint function of MIPPO group was evaluated after fracture healing.Results All the 78 patients were follow-up for(17.3±2.8)months.The incision length,fracture healing time and intraoperative bleeding in MIPPO group were significantly shorter than those in ORIF group.The UCLA scores of shoulder joint in MIPPO group were 29.04±1.63 and 30.95±1.69 at 3 and 6 months after operation,which were higher than those in ORIF group 22.11±2.33 and 25.96±2.01.The shoulder function Constant-Murley scores of MIPPO group were 55.64±2.83 and 75.01±5.71 at 3 and 6 months after operation, which were higher than those of ORIF group 45.03±6.32 and 64.61 ±6.77. However, there was no significant difference between the two groups in the shoulder function Constant-Murley score and the last shoulder function grade at 12 months after operation. After fracture healing, the shoulder function of MIPPO group was further evaluated: the average flexion angle was 170.5 ° (ranged, 161° to 180°), the average external rotation angle was 71° (ranged, 63.5° to 83.5°), the average internal rotation angle was 73.6 ° (ranged, 68° to 79°) and the recovery of mobility was good. The complication rate of MIPPO group was 5.56%, which was better than that of ORIF group 11.90% (P<0.05). Conclusion Both MIPPO and ORIF can treat proximal humerus fractures of Neer type III and IV . The former is superior to the latter in incision length, bleeding volume, fracture healing time,shoulder joint function recovery at 3 and 6 months after operation, complications and other aspects, which is worth clinical promotion.