摘要
目的比较切开复位内固定（ORIF）与微创经皮钢板接骨术（MIPPO）治疗复杂肱骨近端骨折的疗效。方法回顾性分析2014年1月至2015年10月收治的55例复杂肱骨近端骨折患者资料，男32例，女23例；年龄21～81岁，平均51岁。骨折根据Neer分型：三部分骨折34例，四部分骨折21例，其中脱位14例。根据治疗方式不同分为2组：ORIF组35例（采用ORIF内固定治疗），MIPPO组20例（采用MIPPO技术内固定治疗）。记录并比较两组患者手术时间、术中出血量等。末次随访时采用Neer评分评定肩关节功能。两组患者术前一般资料比较差异无统计学意义（P〉0．05），具有可比性。结果55例患者术后获6～12个月（平均9个月）随访。MIPPO组患者患者手术时间[（100．5±10．2）min】、术中出血量[（80．0±10．5）mL]、切口长度[（7．5±3．2）cm】均优于ORIF组【（120．0±10．1）min、（200．5±10．2）mL、（10．5±5．3）cmJ，差异均有统计学意义（P〈0．05）。末次随访时采用Neer评分评定肩关节功能：ORIF组与MIPPO组优良率分别为71．4％（25／35）、85．0％（17／20），差异有统计学意义（P〈0．05）。ORIF组术后肱骨头缺血坏死患者数（15例）明显多于MIPPO组（3例），差异有统计学意义（P〈0．05）。结论对于复杂肱骨近端骨折，较ORIF技术，采用MIPPO技术治疗局部血供破坏较少、创伤小、术后患者恢复较快，患肢功能通过早期功能锻炼恢复较好。
Objective To compare open reduction and internal fixation （ORIF） and minimally in- vasive percutaneous plate osteosynthesis （MIPPO） in the operative treatment of complicated proximal humeral fractures. Methods From January 2014 to October 2015, 55 complicated proximal humeral fractures were treated at our department. They were 32 men and 23 women, from 21 to 81 years of age （average, 51 years） . According to Neer classification, 34 cases belonged to three-part fractures and 21 ones to four-part fractures, 14 of which were complicated with dislocation. Of them, 35 received ORIF and 20 underwent MIPPO. The 2 groups were compared in terms of operation time, intraoperative blood loss, incision length and Neer scoring of the shoulder function at the final follow-ups. The 2 groups were compatible without significant differences in preoperative demographic data （ P 〉 0.05 ）. Results The 55 patients were followed up for 6 to 12 months（mean, 9 months） . The operation time （100. 5 ± 10.2 min）, intraoperative blood loss （80.0 ±10.5 mL）, and incision length （7.5 ± 3.2 cm） in the MIPPO group were significantly better than those in the ORIF group （120. 0 ± 10. 1 min, 200.5 ± 10. 2 mL, and 10.5 ±5.3 cm, respectively） （ P 〈 0.05） . According to the Neer scoring of the shoulder function at the final follow-ups, the good to excellent rate was 71.4% （25/35） in the ORIF group and 85.0% （17/20） in the MIPPO group, showing a signifi- cant difference （ P 〈 0.05）. The incidence of humeral head necrosis was 15 in the OPdF group, significantly higher than that （3） in the MIPPO group （ P 〈 0. 05）. Conclusion In treatment of complex proximal humeral fractures, compared with ORIF, MIPPO may lead to less damage to local blood supply, less trauma, and quicker functional recovery due to early functional exercise.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第7期592-596,共5页
Chinese Journal of Orthopaedic Trauma
关键词
肩骨折
外科手术
微创性
骨折固定术
内
Shoulder fractures
Surgical procedures, minimally invasive
Fracture fixation,internal
