摘要
目的：采用手法闭合复位经皮运用锁定接骨板微创固定治疗肱骨近端骨折与常规切口切开复位内固定治疗肱骨近端骨折,比较两种方法临床效果.方法：2008年4月至2012年3月,75例肱骨近端骨折,男26例,女49例;年龄22～80岁,平均52.1岁;受伤至手术时间平均2.2d;分为微创组和常规组.微创组33例,男12例,女21例;平均年龄（47.30±8.72）岁;Neer分型Ⅱ型22例,Ⅲ型11例;在手法闭合复位后,采用锁定接骨板经肩峰下三角肌小切口插入固定进行治疗.常规组42例,男16例,女26例;平均年龄（49.10±9.29）岁;Neer分型Ⅱ型27例,Ⅲ型15例;手术经常规的三角肌胸大肌间隙入路,显露骨折端,直视下复位后用锁定接骨板固定治疗.分别记录两种术式的手术操作时间、出血量和手术切口长度;应用VAS评分记录术后1、3d手术伤口疼痛情况;比较两组骨折愈合时间,随访记录采用Constant-Murley评分对疗效进行评定并进行两组比较,同时比较两种患者术后肩关节正位X线片上肱骨近端颈干角.结果：75例均获随访,时间8～24个月.微创组手术切口（6.74±0.38） cm,常规组（16.82±1.74） cm,微创组较常规组切口小;微创组出血（110.15±29.49） ml,常规组（326.19±59.71）ml,微创组较常规组出血少;微创组手术时间（48.60±10.18） min,常规组（68.84±16.22） min,微创组较常规组手术时间短.常规组3例出现骨不连并再次手术,2例出现肱骨头坏死.微创组Constant-Murley评分88.94±2.57,常规组86.00±3.36,微创组评分高于常规组.结论：手法复位经皮运用锁定接骨板微创固定治疗肱骨近端骨折,既能减少手术创伤,又能保证关节的早期功能活动,使肩关节功能迅速恢复,具有创伤小、血运破坏少、固定可靠等优点,与常规手术方法相比更具有优势.
To compare the clinical effects of close manipulative reduction combined with minimally invasive percutaneous plate fixation （MIPPO） and conventional open reduction and internal fixation （ORIF） for the treatment of proximal humerus fractures. Methods：From April 2008 to March 2013, among the 75 patients with fractures of proximal humerus, 26 patients were male and 49 patients were female, ranging in age from 22 to 80 years ; 18 patients had injuries caused by traffic accident and 57 patients had injuries caused by falling down. According to Neer classification, there were 49 cases of two- part fractures and 26 cases of three-part fractures. All the patients were divided into two groups ： MIPPO group and ORIF group. There were 12 males and 21 females in the MIPPO group,including 22 cases of Neer two parts and II cases of Neer three parts, who were treated with close manipulative reduction combined with MIPPO. While the other 42 patients were in the ORIF group,including 16 males and 26 females. Among those patients,27 cases belonged to Neer two parts and 15 cases of Neer three parts, who were treated with ORIF. Length of the incision, blood loss, operating time, early postoperative pain （recorded by VAS）, neck-shaft angle of proximal humerus and postoperative function of shoulder（recorded by Constant-Murley score, including pain, function, ROM and muscle length） were compared. Results：The mean lengths of incision were （6.74±0.38） cm in MIPPO group and （16.82±1.74） cm in ORIF group;blood losses were （110.15±29.49） ml in MIPPO group and （326.19± 59.71 ） ml in ORIF group; operation times were （48.60±10.18） min in MIPPO group and （68.84±16.22） min in ORIF group.VAS of patients in MIPPO group on the 1st and 3rd days postoperatively were lower than those of patients in the ORIF group. The postoperative radiographs verified good position of all screws and satisfactory reduction of bone fracture reduction in both groups. All the patients were followed up,and the durig ranged from 8 to 24 months （mean 14.2 months）. In the MIPPO group, there was no humeral head necrosis and all patients gained bone union; while in the ORIF group,3 patients sustained nonunion and received reoperation for bone grafting, and 2 patients sustained humeral head necrosis. The mean Constant-Murley scores of shoulder were 88.94±2.57 in the MIPPO group and 86.00±3.36 in the ORIF group. Conclusion：The close manipulative reduction combined with MIPPO is a better choice for fixation of proximal humerus fractures, compared with conventional plate. This method possesses such advantages as a shorter incision,less disturbance of the blood supply and stable fixa- tion of the fracture, allowing early exercise so that the function of shoulder recovers rapidly.
出处
《中国骨伤》
CAS
2014年第4期311-315,共5页
China Journal of Orthopaedics and Traumatology
基金
海派中医流派传承基地项目(编号:ZYSNXD-CC-HPGC-JDD-001)
"中医骨伤科学"国家重点学科(编号:100508)
上海领军人才项目(编号:041)
上海市科委重点项目(编号:09dZ1973800)
上海市卫生局中医药科研专项(编号:2010L018A)~~
关键词
肱骨骨折
复位
外科手术
病例对照研究
Humeral fractures
Reduction
Surgical procedures,operative
Case-control studies
