应用MIPO技术经肩峰前外侧入路治疗肱骨近端骨折的疗效观察  

Curative effect Observation of Using Minimal Invasive Plate Osteosynthesis Technique through Anterolateral Acromial Approach for the Treatment of Proximal Humeral Fractures

作　　者：陈孝均[1] 肖继冲 邹永根[1] 张箭[1] 杨杰翔[1] 陶源[1] 

机构地区：[1]泸州医学院附属中医医院,四川泸州646000 [2]四川省泸州王氏骨科医院

出　　处：《中国医学创新》2015年第24期136-140,共5页Medical Innovation of China

摘　　要：目的：评价应用微创钢板接骨（minimally invasive plate osteosynthesis,MIPO）技术肱骨近端内锁定系统（Proximal Humeral Internal Locking System,PHILOS）钢板经肩峰前外侧入路治疗肱骨近端骨折的临床疗效。方法：选取2012年4月-2014年3月应用MIPO技术PHILOS钢板经肩峰前外侧入路治疗的38例肱骨近端骨折患者,其中男20例,女18例;年龄27~82岁,平均62.2岁;伤后手术时间2~17 d,平均4.7 d;Neer二部分骨折12例,三部分骨折19例,四部分骨折7例。自肩峰前0.5 cm处向下切开皮肤,长约6 cm,沿肌纤维方向劈开三角肌,显露骨折,直视下间接复位骨折,用克氏针临时固定,在肌层深面向远端插入PHILOS钢板,近端软组织手术窗用5~6枚锁定螺钉固定肱骨头,下方软组织手术窗植入3~4枚螺钉固定肱骨干。结果：本组病例手术时间45~110 min,平均75 min;术中出血60~155 m L,平均95 m L;切口均一期愈合。38例得到平均9.3个月（6~18个月）的随访,骨折均愈合,愈合时间15.2周（11~29周）。术后一年内,肩关节Neer评分优（〉90分）19例,良（80~89分）15例,可（71~79分）3例,差（≤70分）1例,优良率为89.5%。结论：应用MIPO技术PHILOS钢板经肩峰前外侧入路治疗肱骨近端骨折具有创伤小、术中出血少、手术时间短、骨折愈合快、肩关节功能恢复好等优点。手术过程中必须对腋神经加以保护。该术式是治疗肱骨近端骨折的一种较好的方法,但与常规的经胸大肌三角肌间隙入路相比,如要明确哪种入路更为优良,则需要进一步增加患者数量来进行比较研究。Objective： To investigate the curative effect of using minimally invasive plate osteosynthesis （ MIPO ） technique through anterolateral acromial approach for the treatment of proximal humerus fractures with proximal humeral internal locking system （ PHILOS ） plate.Method： From April 2012 to March 2014, 38 eases of proximal humerus fractures were treated with MIPO technique through anterolateral acromial approach with PHILOS plate.There were 20 males and 18 females, and the average age was 62.2 years （ range 27-82 years ） and the average time was 4.7 days （ range, 2-17 days ） between injury and operation, including 12 cases of Neer Ⅱ , 19 eases of Neer Ⅲ, and 7 eases of Neer IV .Starting from 0.5 cm anterior to the acromion, the skin was incised from 6 cm in length and the deltoid muscle was separated along the muscle fibers to expose the fracture fragments.Under direct vision the indirect reduction of the fracture was performed and the fragments were temporarily fixed with K-wires.The PHILOS plate was inserted distally beneath the deltoid muscle and the position between the distal plate and the humeral shaft was adjusted through another small skin incision on the lateral upper arm.5-6 locking screws were inserted to the proximal plate to fix the fracture fragments while 3-4 screws were inserted to the distal plate to fix it to the humeral shaft. Result： This series experienced a primary wound healing, a mean operation time was 75 min （ range, 45-110 min ）, and a mean intraoperative blood loss was 95 mL （ range 60-155 mL ） .All the 38 cases were followed up ranging from 6 to 18 months with an average of 9.3 months.The bone healing time was 15.2 weeks （ range 11-29 weeks ） .The functional results of the shoulder, according to Neer scores was evaluated within 1 year after operation, were classified as excellent in 19 cases, good in 15 cases, fair in 3 cases, and poor in 1 case, the excellent and good rate was 89.5%.Conclusion： Using MIPO technique through anterolateral acromia

关 键 词：微创钢板接骨术 肩峰前外侧入路 肱骨近端骨折 肱骨近端内锁定系统钢板 

分 类 号：R687.3[医药卫生—骨科学]