肩峰前外侧经皮微创内固定技术联合肱骨近端解剖锁定内固定系统治疗老年肱骨近端骨质疏松性骨折的疗效

Clinical efficacy of anterolateral acromippo technique combined with philos in treatment of osteoporotic proximal humeral fractures in the elderly

目的观察肩峰前外侧经皮微创内固定(MIPPO)技术联合肱骨近端解剖锁定内固定系统(PHILOS)治疗老年肱骨近端骨质疏松性骨折患者的临床治疗效果及安全性。方法选择2017年1月至2019年12月在我院采用PHILOS治疗的老年肱骨近端骨质疏松性骨折患者65例,根据手术技术不同,随机分为两组,MIPPO组(n=34),采用肩峰前外侧MIPPO技术联合PHILOS治疗;ORIF组(n=31),采用经三角肌胸大肌切开复位内固定术联合PHILOS治疗。术前两组组间性别分布、损伤原因、受伤侧、术前准备时间等资料比较差异均无统计学意义(P>0.05)。比较两组术中(手术用时、手术切口长度等资料)、术后并发症发生情况以及骨折愈合时间;术后第1、3天采用疼痛视觉模拟评分(VAS评分)评估肩部疼痛程度;术后12个月采用肩关节Neer功能评分评估其临床治疗效果。结果MIPPO组术中用时、出血量、手术切口长度、术后住院时间和骨折愈合时间均优于ORIF组(P<0.05)。术后第1、3天VAS评分MIPPO组显著低于ORIF组(P<0.05)。术后第12个月随访时肩关节Neer评分MIPPO组优于ORIF组(P<0.05)。结论肩峰前外侧经皮微创内固定技术联合肱骨近端解剖锁定内固定系统治疗老年肱骨近端骨质疏松性骨折安全、有效,具有软组织损伤小、住院时间短等优点,适宜推广应用。

Objective To observe the clinical efficacy and safety of anterolateral acromion percutaneous minimally invasive internal fixation(Minimally invasive percutaneous plate osteosynthesis,MIPPO)technique in the treatment of elderly patients with osteoporotic fractures of the proximal humerus.Methods Elderly patients with proximal humeral osteoporotic fractures treated with the proximal humeral locking internal fixation system(PHILOS)in our hospital from January 2017 to December 2019 were randomly divided into MIPPO group(34 cases treated with anterolateral acromion MIPPO technique combined with PHILOS)and ORIF group(31 cases treated with transdeltoid pectoralis major open reduction and internal fixation combined with PHILOS treatment).There was no statistical significance in the comparison of sex distribution,age,injured side,preoperative preparation time and other data between the two groups before operation(P>0.05).The intraoperative(operation time,surgical incision length,etc.),postoperative complications,and fracture healing time were observed in the two groups;the pain visual analog scale(VAS score)was used to evaluate the shoulder pain on the 1st and 3rd day after the operation;the Neer function score of the shoulder joint was used to evaluate the clinical treatment effect after 12months.Results There were less blood loss,and shorter intraoperative time,surgical incision length,postoperative hospital stay and fracture healing time in the MIPPO group(P<0.05).The VAS score of the MIPPO group was significantly lower than that of the ORIF group on the 1st and 3rd day after operation(P<0.05).The Neer score of shoulder joint in the MIPPO group was higher than that in the ORIF group in the follow-up after 12 months(P<0.05).Conclusion Anterolateral acromion percutaneous minimally invasive internal fixation is safe and effective in the treatment of senile osteoporotic fractures of proximal humerus.It has the advantages of small soft tissue injury and short hospital stay,and is suitable for popularization.