肩峰下横切口微创接骨板内固定治疗肱骨近端骨折的临床分析及手术技巧  

Clinical outcome and surgical skills of small incision of locking proximal humeral plate in treating proximal humeral fractures

作　　者：张笑[1] 张鹏举[1] 谢冰[1] 郭岩凤[1] 

机构地区：[1]首都医科大学密云教学医院骨科,北京101500

出　　处：《中国骨与关节外科》2016年第1期49-52,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景：临床多采用三角肌胸大肌间隙入路的传统开放手术治疗肱骨近端骨折，但手术创伤大、出血多、恢复慢。近年来，应用微创接骨板内固定技术（minimally invasive percutaneous plate osteosynthesis, MIPPO）治疗肱骨近端骨折逐渐被应用于临床。目的：总结和评价应用肩峰下横切口，经三角肌外侧入路MIPPO结合肱骨近端锁定接骨板（locking proximal humerusplate, LPHP）治疗肱骨近端骨折的临床疗效和手术技巧。方法：2012年10月至2014年10月，应用经三角肌外侧入路MIPPO技术治疗21例肱骨近端骨折患者，男8例，女13例；年龄28-79岁，平均（67.5±1.5）岁。根据Neer分型：二部分骨折12例，三部分骨折5例，四部分骨折4例。结果：本组21例全部获得随访，随访时间为6-13个月，平均（9.6±2.3）个月。均达到骨性愈合，骨折愈合时间14-17周，平均愈合时间为（16.2±1.4）周。根据Neer评分，优17例、良2例、可2例，优良率为90.5%。VAS评分，优18例，良2例，可1例，优良率为95.2%。结论：应用MIP-PO技术治疗肱骨近端骨折具有创伤小、血运破坏少、术中出血少、手术时间短，骨折愈合率高、肩关节功能恢复好等优点，在正确掌握手术技巧的前提下，MIPPO技术是治疗肱骨近端骨折的较好方法。Background：The conventional deltopectoral approach was used in the treatment of proximal humeral fractures. But there are more intraoperative blood loss, more postoperative pain and longer hospital stay. Minimally invasive percuta-neous plate osteosynthesis （MIPPO） has been used in recent years. Objective：To evaluate surgical techniques and clinical re-sults of MIPPO combined with locking proximal humeral plate （LPHP） through deltopectoral approach in treating proximal humeral fractures. Methods：From October 2012 to October 2014, 21 cases of proximal humeral fractures were treated using small incision of LPHP. There were 8 males and 13 females with an average age of （67.5 ± 1.5） years （range, 28-79 years）. According to Neer classification, there were 12 cases of two-part fractures, 5 of three-part fractures and 4 of four-part frac-tures. Results：The follow-up period of the 21 cases ranged from 6 to 13 months, the average being （9.6±2.3） months. Bone union was achieved in all patients, and the mean healing time was （16.2 ± 1.4） weeks （range, 14-17 weeks）. Neer scoring showed excellent results in 17 patients, good in 2 and fair in 2. VAS scoring presented excellent results in 18 patients, good in 2 and fair in 1. Conclusions： Small incision of LPHP possesses such advantages as smaller trauma, less disturbance of blood supply, less bleeding, shorter operation time and less complications. It is an effective method to treat proximal humer-al fractures if the proper operation skills are executed.

关 键 词：小切口 肱骨近端锁定接骨板 肱骨近端骨折 

分 类 号：R687.32[医药卫生—骨科学]