微创锁定钢板内固定术在肱骨近端骨折中的应用及对患者肩关节活动度、桡神经损伤的影响  

Application of minimally invasive locking plate internal fixation in proximal humeral fracture and its effect on shoulder joint range of motion and radial nerve injury

作　　者：陈辉 王建法 李志磊 CHEN Hui;WANG Jianfa;LI Zhilei(Spine Surgery Department of Zhengzhou Yangcheng Hospital,Zhengzhou 452470,China;Department of Neurospinal Surgery,Zhengzhou Central Hospital)

机构地区：[1]郑州阳城医院脊柱外科,河南郑州452470 [2]郑州市中心医院神经脊柱外科

出　　处：《潍坊医学院学报》2023年第1期70-73,共4页Acta Academiae Medicinae Weifang

摘　　要：目的探究微创锁定钢板内固定术(MIPPO)治疗肱骨近端骨折(PHFs)患者的效果。方法选取74例PHFs患者(2019年6月~2022年3月),按随机数字表法分成A组(n=37)、B组(n=37)。B组接受切开复位内固定术(ORIF)治疗,A组接受MIPPO治疗。对比2组手术指标、手术前后视觉模拟评分法(VAS)评分、肩关节活动度、骨痂生长、Constant-Murley肩关节功能评分、骨保护素(OPG)、核转录子-κB受体活化因子(RANK)、核转录子-κB受体活化因子配体(RANKL)水平、并发症发生率。结果与B组比较,A组骨折愈合时间、住院及手术时长更短,术中失血量更少(P<0.05),术后3d、7d,A组VAS评分更低(P<0.05)。术后1个月、3个月,A组骨痂生长评分更高(P<0.05);肩关节上举及外展活动度及Constant-Murley评分更高(P<0.05);血清OPG水平更高,血清RANK、RANKL水平更低(P<0.05)。与B组并发症总发生率21.62%(8/37)相比,A组2.70%(1/37)更低(P<0.05)。结论应用MIPPO治疗在优化手术指标、减轻疼痛感、提高肩关节功能及活动度、促进骨痂生长、减少并发症方面更具优势,且更有助于促进骨折愈合。Objective To investigate the effect of minimally invasive locking plate internal fixation(MIPPO)in the treatment of proximal humeral fractures(PHFs).Methods From June 2019 to March 2022,a total of seventy-four patients with PHFs admitted to the hospital were randomly divided into group A(n=37)and group B(n=37).Group B received open reduction and internal fixation(ORIF)and group A received MIPPO.The operation indexes,visual analogue scale(VAS)score before and after operation,shoulder joint range of motion,callus growth,Constant-Murley shoulder joint function score,bone metabolism:osteoprotegerin(OPG),receptor activator of nuclear factor-kappaB(RANK),receptor activator of nuclear factor-kappaB ligand(RANKL)level and complication rate of two groups were compared.Results Compared with group B,group A had shorter fracture healing time,shorter hospitalization and operation time,and less intraoperative blood loss(P<0.05);Compared with group B,the VAS scores in group A were lower three and seven days after operation(P<0.05);The callus growth scores in group A were higher than that in group B one month and three months after operation(P<0.05);Group A had higher shoulder joint lift and abduction range of motion and Constant-Murley score one month and three months after operation,than those in group B(P<0.05);In comparison with group B,group A had higher serum OPG levels and lower serum RANK and RANKL levels one month and three months after operation(P<0.05);The total complication rate 2.70%(1/37)in group A was lower than 21.62%(8/37)in group B(P<0.05).Conclusion Compared with the treatment of PHFs,MIPPO treatment has more advantages in optimizing surgical indicators,reducing pain,improving shoulder joint function and mobility,promoting callus growth,reducing complications,which is more conducive to promoting fracture healing.

关 键 词：肱骨近端骨折 微创锁定钢板内固定术 肩关节活动度 骨代谢 

分 类 号：R683.41[医药卫生—骨科学]