两种手术方式治疗肱骨近端骨折的疗效比较  

Comparison of effect of two surgical methods in the treatment of proximal humerus fractures

作　　者：姜世斌 毛兆光[1] 毛建华[1] JIANG Shi-bin;MAO Zhao-guang;MAO Jian-hua(Dept of Orthopaedics,the People′s Hospital of Jiangshan City,Jiangshan Branch of Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Jiangshan,Zhejiang 324100,China)

机构地区：[1]江山市人民医院(浙江大学医学院附属邵逸夫医院江山分院)骨科,浙江江山324100

出　　处：《临床骨科杂志》2025年第1期73-77,共5页Journal of Clinical Orthopaedics

基　　金：浙江省江山市科技局科技计划项目(编号:JS2020D044)。

摘　　要：目的比较经皮微创接骨板内固定技术(MIPPO)与传统切开复位内固定术(ORIF)治疗NeerⅡ、Ⅲ型肱骨近端骨折的疗效。方法将80例肱骨近端骨折患者根据手术方法不同分为MIPPO组(采用MIPPO治疗)与ORIF组(采用ORIF治疗),各40例。比较两组手术情况、骨折复位角度、骨折愈合时间、疼痛VAS评分、肩关节活动度、肩关节功能Constant-Murley评分和并发症发生率。结果患者均获得随访,时间6~12个月。术中透视次数MIPPO组多于ORIF组(P<0.05),切口长度、手术时间、术中出血量、骨折愈合时间MIPPO组均短(少)于ORIF组(P<0.05)。肱骨颈干角、肱骨头后倾角ORIF组均优于MIPPO组(P<0.05)。术后3、6、9周疼痛VAS评分MIPPO组均低于ORIF组(P<0.05)。肩关节活动度术后9周前屈、后伸、外展、外旋和术后12周前屈、后伸、外展MIPPO组均大于ORIF组(P<0.05)。术后3个月肩关节功能Constant-Murley评分MIPPO组高于ORIF组(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论相较于ORIF,MIPPO治疗NeerⅡ、Ⅲ型肱骨近端骨折具有创伤小、出血少、骨折愈合快、早期肩关节功能恢复更好等优点,但也存在术中透视次数多、因术中暴露不充分影响骨折复位质量等缺点。Objective To compare the efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)and traditional open reduction and internal fixation(ORIF)in the treatment of Neer typeⅡ,Ⅲproximal humerus fractures.Methods The 80 patients with proximal humeral fractures were randomly divided into MIPPO group(treated with MIPPO)and ORIF group(treated with ORIF),according to different surgical methods,with 40 cases in each group.Surgery condition,fracture reduction angle,fracture healing time,pain VAS,range of shoulder joint motion,Constant-Murley score of shoulder joint function and complication incidence were compared between the two groups.Results All patients were received postoperative follow-up of 6~12 months.The intraoperative fluoroscopy frequency in the MIPPO group was more than that in the ORIF group(P<0.05),the incision length,operation time,and the intraoperative blood loss,fracture healing time in the MIPPO group were all shorter(less)than those of ORIF group(P<0.05).The humeral neck-shaft angle,slope angle of humeral head in the ORIF group were better than MIPPO group(P<0.05).At 3,6,and 9 weeks postoperation,the VAS of MIPPO group was lower than the ORIF group(P<0.05).For the anteflexion,posterior extension,abduction,and external rotation of the shoulder joint activity,the data of postopertaive 9 weeks in the MIPPO group were larger than those of ORIF group(P<0.05).At 3 months postoperation,Constant-Murley score of shoulder joint in the MIPPO group was higher than that of ORIF group(P<0.05).The complication incidence of two groups had no statistical difference(P>0.05).Conclusions Compared to ORIF,MIPPO treatment for Neer typeⅡ,Ⅲproximal humeral fractures has advantages such as less trauma,less intraoperative blood loss,faster fracture healing,and better early recovery of shoulder joint function.However,there are also drawbacks such as excessive intraoperative fluoroscopy frequency and insufficient intraoperative exposure,which can affect the quality of fracture reduction.

关 键 词：经皮微创接骨板固定技术 传统切开复位内固定术 肱骨近端骨折 

分 类 号：R683.41[医药卫生—骨科学] R687.32[医药卫生—外科学]