三种手术方法治疗老年人肱骨近端二部分骨折的比较研究  

Three surgical treatments of two-part humeral proximal fractures in the elderly patients

作　　者：李健[1] 王瑞[1] 孔晓川[1] 安立琨[1] 柳伟[1] 杨立辉[1] 洪钢[1] 郭子城[1] 

机构地区：[1]首都医科大学附属北京朝阳医院骨科,100043

出　　处：《中华创伤骨科杂志》2012年第4期283-287,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨采用肱骨髓内钉、切开复位内固定术（ORIF）及经皮微创接骨板技术（MIPPO）3种方法治疗老年人肱骨近端二部分骨折的疗效。方法回顾性分析2006年1月至2009年12月收治的49例肱骨近端二部分骨折患者资料，男12例，女37例；年龄54～7l岁，平均65．7岁。其中采用肱骨髓内钉（髓内钉组）治疗18例，ORIF（ORIF组）治疗12例，MIPPO组（MIPPO组）治疗19例。对患者术前、术中情况、骨折愈合情况、并发症及功能恢复情况进行比较。结果49例患者术后均获8～36个月（平均17．8个月）随访。髓内钉组、ORIF组及MIPPO组的切口平均长度分别为（7．1±0．3）cm、（13．7±0．9）cm、（12．1-t-0．8）cm；术中出血量平均分别为（58．3±20．7）mL、（283．3±44．4）mL、（96．3±9．0）mL；3组之间两两比较差异均有统计学意义（P〈0．05）；髓内钉组平均手术时间l（90．5±18．5）minl少于ORIF组[（1l1．3±16．7）nlin]和MIPPO组[（112．4±9．9）rain]，比较差异有统计学意义（P〈0．05）；3组之间骨折愈合时间、术后功能恢复优良率相当，比较差异无统计学意义（P〉0．05）。结论3种方法治疗老年人肱骨近端二部分骨折均可获得较好效果，但髓内钉具有创伤小、手术时间短的优点．是一种较为合适的治疗方法。Objective To compare humeral intramedullary nailing （HIN）, open reduction and in- ternal fixation （ORIF） and minimallv invasive pereutaneous plate osteosynthesis （MIPPO） in treatment of two-part humeral proximal fractures in the elderly patients. Methods From January 2006 to December 2009, 49 patients with fiacture of hmneral surgical neck were treated by HIN, ORIF and MIPPO. They were 12 men and 37 women, with an average age of 65.7 years （from 54 to 71 years） . There were 18 eases in group A （HIN）, 12 in group B （ORIF） and 19 in group C （MIPPO）. The preoperative conditions, fracture healing, complications and functional recovery were compared between the 3 methods. Results All the 49 patients were tbllowed up for 8 to 36 months （average, 17.8 months）. The mean incision length was 7. 1 ±0. 3 cm in group A, 13.7 ±0. 9 em in group B and 12. 1 ±0.8 cm in group C; the mean operative blood loss was 58.3±20.7 mLin group A, 283.3±44.4 mLingroup B and 96.3±9.0mLingroupC. There were significant differences between the 3 methods（ P 〈 0.05）. The HIN had the shortest incision and the least operative blood loss. lu the mean operative time, HIN[（90.5± 18.5） rain] was significantly better than ORIF [ [ （ 111.3 ± 16.7） rain] and MIPPO[ （ 112.4 ±9.9） mini （ P 〈 0. 05） . There were no significant differences in the fracture healing time and tunctional recovery, between the 3 groups （ P 〉 0.05）. Conclusions Although the 3 methods can produce similar efficacy in the treatment of two-part humeral proximal fractures in the elderly patients, the humeral intramedullary nailing has an advantage over the other two in operative invasion and operative time.

关 键 词：肱骨骨折 近端 骨折固定术 内 骨板 

分 类 号：R687.3[医药卫生—骨科学]