MIPO技术结合锁定加压钢板治疗肱骨近端骨折的前瞻性研究  

Minimally invasive plate osteosynthesis technique combined with locking plate for treating proximal humerus fractures-a prospective study

作　　者：杨万贵[1] 王应兵 王川[1] 钟凤林[1] Yang Wangui;Wang Yingbing;Wang Chuan;Zhong Fenglin(Department of Orthopedics,Panzhihua Central Hospital,Panzhihua,Sichuan 617067,China)

机构地区：[1]攀枝花市中心医院骨科,四川攀枝花617067

出　　处：《创伤外科杂志》2022年第4期295-300,共6页Journal of Traumatic Surgery

摘　　要：目的探讨肩峰下外侧入路经皮微创钢板内固定术(MIPO)结合锁定加压钢板及三角肌-胸大肌手术入路对于治疗肱骨近端骨折的影响。方法前瞻性研究2018年1月—2018年12月四川省攀枝花市中心医院骨科收治的肱骨近端骨折患者60例,其中男性34例,女性26例;年龄62~75岁,平均66.2岁;右侧41例,左侧19例;道路交通伤31例,平地摔伤18例,高处坠落伤6例,扭伤5例。将患者随机分为对照组和试验组,各30例。对照组行胸大肌三角肌肌间沟入路钢板内固定,试验组行MIPO技术结合锁定加压钢板内固定。分析比较两组患者在手术时间、切口长度、术中出血量、住院时间、骨折愈合时间、肩关节功能评分、术后并发症情况等方面的差异。结果试验组平均手术时间(69.4±13.4)min、切口长度(7.9±1.2)cm、术中出血量(73.2±8.7)mL、住院时间(6.4±2.1)d,对照组分别为(105.3±15.3)min、(14.5±1.6)cm、(121.2±23.2)mL、(8.4±3.1)d,试验组患者围术期各临床指标较对照组患者明显降低(P<0.05)。试验组平均骨折愈合时间(73.1±5.7)d少于对照组(94.3±5.8)d,P<0.05;试验组患者术后3、6、12个月Constant-Murley评分分别为(63.1±5.3)分、(77.8±2.5)分、(87.2±6.1)分,对照组患者为(61.8±3.1)分、(76.2±5.3)分、(87.2±3.9)分,试验组术后3个月Constant-Murley评分均优于对照组(P<0.05),但术后6、12个月时两组差异无统计学意义(P>0.05)。试验组患者术后3、6、12个月时美国加州大学(ULCA)肩关节功能评分分别为(25.3±3.2)分、(29.3±2.9)分、(32.7±3.7)分,对照组(23.1±3.7)分、(25.2±5.2)分、(30.3±3.9)分,试验组术后3、6个月UCLA评分均优于对照组患者(P<0.05),但12个月时两组患者差异无统计学意义(P>0.05)。对照组12例患者出现并发症(40.0%),试验组5例患者术后出现并发症(16.7%),试验组并发症发生率较对照组明显降低(P<0.05)。结论MIPO技术结合锁定加压钢板治疗肱骨近端骨折具有�Objective To investigate the effect of minimally invasive plate osteosynthesis(MIPO)combined with locking compression plate and deltoid-pectoralis major surgical approach on the treatment of proximal humeral fractures.Methods Totally 60 patients with proximal humeral fractures,including 34 males and 26 females,were prospectively selected from the Department of Orthopedics of Panzhihua Central Hospital of Sichuan Province from Jan.2018 to Dec.2018.Their age ranged from 62-75 years,with an average of 66.2 years.Right side was injured in 41 cases,and left side in 19 cases.There were 31 cases of road traffic injury,18 cases of falling on flat ground,6 cases of falling from high place and 5 cases of sprain.All patients were randomly divided into control group and experimental group,with 30 cases in each group.The control group received internal fixation with intermuscular groove of pectoralis major deltoid,and the experimental group received internal fixation with MIPO technique combined with locking compression plate.The differences in operative time,incision length,intraoperative blood loss,length of hospital stay,fracture healing time,shoulder function score and postoperative complications between the two groups were analyzed and compared.Results The average operation time,incision length,intraoperative blood loss and hospital stay in experimental group were(69.4±13.4)minutes,(7.9±1.2)cm,(73.2±8.7)mL and(6.4±2.1)days,respectively.In the control group were(105.3±15.3)minutes,(14.5±1.6)cm,(121.2±23.2)mL,(8.4±3.1)days,respectively.Perioperative clinical indexes in experimental group were significantly lower than those in control group(P<0.05).The average healing time of the experimental group was(73.19±5.78)days,which was(94.38±5.89)days in control group,and the difference between the two groups was statistically significant(P<0.05).Constant-murley scores of experimental group were(63.1±5.3)points,(77.8±2.5)points,(87.2±6.1)points at 3,6 and 12 months after surgery,respectively.The scores in the control g

关 键 词：肱骨近端骨折 手术入路 微创 钢板 内固定 

分 类 号：R683.41[医药卫生—骨科学]