摘要
目的比较手法复位微创技术（MIPO）锁定钢板内固定与传统入路锁定钢板内固定治疗老年肱骨近端骨折的临床疗效。方法回顾性分析自2010—03-2014—09诊治的85例肱骨近端骨折．40例采用手法复位MIPO技术锁定钢板内固定（微创组），45例经传统胸三角肌入路切开复位锁定钢板内固定（传统组）。比较2组切口长度、手术时间、术中出血量、术后引流量、手术前后血红蛋白差值、住院时间、骨折愈合时间、并发症、Constant—Murley肩关节功能评分、VAS评分和EQ-5D健康指数。结果85例获得平均22．6（12～48）个月随访。微创组的切口长度、手术时间、术中出血量、术后引流量、手术前后血红蛋白差值、骨折愈合时间、术后3个月Constant—Murley评分，以及术后1周、3个月VAS评分和EQ-5D健康指数均优于传统组，差异有统计学意义（P〈O．05）。而2组住院时间及术后1年的Constant—Murley评分、VAS评分和EQ-5D健康指数差异无统计学意义（P〉0．05）。2组并发症发生率比较差异无统计学意义（x2=1．497，P=0．221）。结论手法复位后经三角肌入路MIP0技术锁定钢板内固定治疗老年肱骨近端骨折在切口长度、手术时间、术中出血量、骨折愈合时间、早期缓解肩关节疼痛、功能恢复及改善生活质量等方面均明显优于传统入路锁定钢板内固定，临床效果良好。
Objective To compare the clinical effects between minimally invasive operation after manual reduction and traditional approach of locking plate in the treatment of proximal humeral fractures of elderly patients. Methods Eighty-five patients with proximal humeral fractures who were treated at our department from Mar. 2010 to Sept. 2014 were analyzed retrospectively; 40 cases were treated with minimally invasive operation after manual reduction and locking plate fixation group （min-group） and the other 45 cases with traditional open reduction and locking plate fixation group （traditional group）. The two groups were compared in terms of surgical incision length, operative time, intraoperative blood loss, postoperative suction drainage, along with the difference of pre- and post-operative hemoglobin, hospital time, fracture healing time, complications, Constant-Murley score, VAS score and EQ-SD health index. Results All the 85 patients were followed up, and the mean follow-up time was 22.6 （12-48） months. Compared with the traditional group, the min-group had significantly shorter incision length and operative time, significantly less intraoperative bleeding and postoperative suction drainage, significantly smaller difference of pre- and post-operative hemoglobin, significantly shorter fracture healing time; the min-group had higher Constant-Murley score at three months postoperatively and VAS score at one week and three months postoperatively than traditional group, and EQ-SD health index of the rain-group was better at one week and three months postoperatively than traditional group （P 〈0.05）. There were no significant differences in hospital time and Constant-Murley score, VAS score and EQ-SD health index results at one year postoperatively between the two groups （P 〉0.05）. And there was no significant difference in the complication rate（x2=1.497,P =0.221）. Conclusion In the treatment of proximal humeral fractures of elderly patients, the minimally invasive approach of locking plate internal fixation after manual reduction has significantly better result than traditional approach in the terms of incision length, operative time, intraoperative blood loss, fracture healing time, early relieve shoulder pain, function recovery and the quality of life improving. So it has good clinical effectiveness.
出处
《中国骨与关节损伤杂志》
2016年第11期1147-1150,共4页
Chinese Journal of Bone and Joint Injury
基金
苏州市医学重点学科项目(Szxk201509)
关键词
肱骨近端骨折
微创
内固定
锁定钢板
老年
Proximal humeral fracture
Minimally invasive
Internal fixation
Locking plate
Elderly
