经皮微创接骨板内固定术与切开复位内固定术治疗NeerⅡ型老年性肱骨外科颈骨折的临床效果比较

Comparison of the clinical effects of minimally invasive percutaneous plate osteosynthesis and open reduction and internal fixation in the treatment of Neer type Ⅱ senile humeral surgical neck fractures

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)治疗NeerⅡ型老年性肱骨外科颈骨折的临床效果。方法选取2016年8月至2020年8月收治的60例NeerⅡ型老年性肱骨外科颈骨折患者,以抽签法按单双号形式随机将其分为对照组和观察组,各30例。对照组采用传统ORIF治疗,观察组采用MIPPO治疗。比较两组的手术相关指标、术后恢复情况、肩关节功能、肩关节活动度及疼痛应激反应指标。结果观察组手术切口长度小于对照组,术中透视次数多于对照组,术中出血量、术后引流量少于对照组,术后2周VAS评分低于对照组,住院时间、骨折愈合时间短于对照组,差异具有统计学意义(P<0.05)。术后3个月,观察组疼痛、关节活动度、肌力、日常社会活动评分均高于对照组,差异具有统计学意义(P<0.05)。观察组术后3个月的肩关节前屈、后伸、内收、外展、内旋、外旋、上举及前屈上举活动度均大于对照组,差异具有统计学意义(P<0.05)。术后7 d,两组的SP、PGE2、NPY水平均升高,但观察组低于对照组,差异具有统计学意义(P<0.05)。结论相较于传统ORIF,采用MIPPO治疗NeerⅡ型老年性肱骨外科颈骨折患者的恢复效果更好,有助于提高患者的肩关节功能恢复效果,促进其肩关节活动度进一步改善,也能减轻疼痛应激反应,值得临床推广和应用。

Objective To compare the clinical effects of minimally invasive percutaneous plate osteosynthesis(MIPPO)and open reduction and internal fixation(ORIF) in the treatment of Neer type Ⅱ senile humeral surgical neck fractures.Methods A total of 60 patients with Neer type Ⅱ senile humeral surgical neck fractures who were admitted from August2016 to August 2020 were selected and randomly divided into control group and observation group according to the form of odd and even numbers by lottery,with 30 cases in each group.The control group was treated with traditional ORIF,the observation group was treated with MIPPO.The operation related indexes,postoperative recovery,shoulder joint function,shoulder joint range of motion and pain stress response indexes were compared between the two groups.Results The length of surgical incision of the observation group was smaller than that of the control group,the number of intraoperative fluoroscopy was more than that of the control group,the amount of intraoperative blood loss and postoperative drainage were less than those of the control group,the VAS score at 2 weeks after operation was lower than that of the control group,hospital stay and fracture healing time were shorter than those of the control group,and the differences were statistically significant(P <0.05).Three months after operation,the scores of pain,range of motion of joint,muscle strength and daily social activity in the observation group were higher than those in the control group,and the differences were statistically significant(P <0.05).The range of motion of flexion,extension,adduction,abduction,internal rotation,external rotation,lifting and flexion and lifting of shoulder joint at 3 months after operation in the observation group were larger than those in the control group,and the differences were statistically significant(P<0.05).At 7 d after operation,the levels of SP,PGE2 and NPY in both groups increased,but those in observation group were lower than the control group,and the differences were statistically significant(P<0.05).Conclusion Compared with the traditional ORIF,the MIPPO applied in treating of Neer type Ⅱ senile humeral surgical neck fractures has a better recovery effect,it helps to improve the recovery effect of shoulder joint function,promote the further improvement of shoulder joint range of motion,and reduce pain stress response,which is worthy of clinical promotion and application.