两种微创钢板内固定技术治疗肱骨干近端骨折临床疗效比较  

Effectiveness comparison of two minimally invasive plate osteosynthesis techniques for proximal humeral shaft fractures

作　　者：王贤[1] 孙可[1] 唐林[1] 梁斌[1] 尹东[1] WANG Xian;SUN Ke;TANG Lin;LIANG Bin;YIN Dong(Department of Orthopedics,the People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning Guangxi,530021,P.R.China)

机构地区：[1]广西壮族自治区人民医院骨科,南宁530021

出　　处：《中国修复重建外科杂志》2023年第2期147-152,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广西医药卫生自筹经费计划课题(桂卫Z2013376)。

摘　　要：目的 比较肱骨外侧入路微创经皮钢板内固定(minimally invasive plate osteosynthesis,MIPO)技术和螺旋钢板MIPO技术治疗肱骨干近端骨折临床疗效的差异。方法 回顾分析2009年12月-2021年4月因肱骨干近端骨折接受外侧入路MIPO手术(A组,25例)和螺旋钢板MIPO手术(B组,30例)治疗的患者临床资料。两组患者性别、年龄、受伤侧别、致伤原因、美国创伤骨科学会(OTA)骨折分型及骨折至手术时间等一般资料比较差异均无统计学意义(P>0.05)。记录手术时间、术中出血量、透视次数及术后早期并发症发生情况;定期随访摄肱骨正侧位X线片评价骨折复位质量及骨折愈合情况;肢体肩、肘关节功能分别采用改良美国加州大学洛杉矶分校(UCLA)肩关节评分和Mayo肘关节功能评分系统(MEPs)评分评价。结果 A组手术时间显著少于B组(P<0.05),两组术中出血量、透视次数比较差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间12~90个月,平均19.4个月,两组随访时间差异无统计学意义(P>0.05)。术后骨折复位质量评价示,A、B组分别有4例(16.0%)和11例(36.7%)患者出现成角畸形,发生率比较差异无统计学意义(χ^(2)=2.936,P=0.087)。所有患者骨折均获骨性愈合,A、B组骨折愈合时间比较差异无统计学意义(P>0.05);A、B组分别有2例和1例出现骨折延迟愈合(愈合时间分别为术后30、42、36周)。A、B组分别有1例患者出现切口浅表感染,分别有2例和1例出现肩峰下撞击,A组3例出现不同程度桡神经麻痹症状,均经对症治疗后治愈;A组总体并发症发生率(32%)显著高于B组(10%)(χ^(2)=4.125,P=0.042)。末次随访时,两组改良UCLA肩关节评分和MEPs评分比较差异均无统计学意义(P>0.05)。结论 外侧入路MIPO手术和螺旋钢板MIPO手术治疗肱骨干近端骨折均能取得良好效果,外侧入路MIPO手术时间更短,而螺旋钢板MIPO总体并发症发生率更低。Objective To compare the effectiveness of lateral approach minimally invasive plate osteosynthesis(MIPO) and helical plate MIPO in the treatment of proximal humeral shaft fractures. Methods The clinical data of patients with proximal humeral shaft fractures who underwent MIPO via lateral approach(group A, 25 cases) and MIPO with helical plate(group B, 30 cases) between December 2009 and April 2021 were retrospectively analyzed. There was no significant difference in gender, age, injured side, cause of injury, American Orthopaedic Trauma Association(OTA)fracture classification, and time from fracture to operation between the two groups(P>0.05). The operation time,intraoperative blood loss, fluoroscopy times, and complications were compared between two groups. The angular deformity and the fracture healing were evaluated according to anteroposterior and lateral X-ray films postoperatively.The modified University of California Los Angeles(UCLA) score for shoulder and the Mayo Elbow Performance(MEP)score for elbow were analyzed at last follow-up. Results The operation time in group A was significantly shorter than that in group B(P<0.05). However, the intraoperative blood loss and fluoroscopy times presented no significant difference between the two groups(P>0.05). All patients were followed up 12-90 months, with an average of 19.4 months. There was no significant difference in follow-up time between the two groups(P>0.05). In terms of the quality of postoperative fracture reduction, there were 4(16.0%) and 11(36.7%) patients with angulation deformity in group A and group B,respectively, and there was no significant difference in the incidence of angulation deformity(χ^(2)=2.936,P=0.087). All fractures achieved bony union, there was no significant difference in fracture healing time between group A and group B(P>0.05);delayed union occurred in 2 cases and 1 case in group A and group B, respectively(healing time was 30, 42, and36 weeks after operation, respectively). In group A and group B, 1 patient had superficial

关 键 词：肱骨干近端骨折 微创经皮钢板内固定 螺旋钢板 

分 类 号：R687.3[医药卫生—骨科学]