微创经皮钢板接骨术结合肱骨近端接骨板治疗肱骨近端二部分、三部分骨折

目的探讨采用微创经皮钢板接骨术（minimally invasive percutaneous plate osteosythesis，MIPPO）技术结合肱骨近端接骨板（locking proximal humerus plate，LPHP）治疗肱骨近端骨折的疗效。方法回顾分析我院2010年3月～2012年4月具有完整随访资料的48例肱骨近端二部分、三部分骨折患者，其中采用MIPPO技术结合LPHP治疗肱骨近端骨折患者27例（MIPPO组），传统切开复位内固定（ORIF）LPHP治疗肱骨近端骨折患者21例（ORIF组）。比较两组的术中情况、骨折愈合时间、住院天数、功能恢复情况及并发症，并进行统计学分析。结果48例术后随访12～24个月（平均15．3个月），MIPPO组切口长度、出血量、手术时间、住院天数、骨折愈合时问等明显优于ORIF组，差异具有统计学意义（P〈0．05）；而并发症及功能恢复情况等比较MIPPO组优于ORIF组，但差异未见统计学意义（P〉0．05）。结论MIPPO技术结合LPHP治疗肱骨近端二部分、三部分骨折符合生物学固定原则，取得较好的疗效，较传统切开复位内固定方法具有轻微优势，是目前治疗肱骨近端二部分、三部分骨折较为合适的方法。

Clinical outcome of MIPPO combined with LPHP in the treatment of two-part and three-part proximal humerus fractures

Objective To discuss the clinical efficacy of MIPPO（minimally invasive percutaneous plate os- teosythesis ） combined with LPHP （ locking proximal humerus plate ） in the treatment of proximal humerus fractures. Methods Retrospective analysis was conducted in 48 cases of proximal humeral two-part/three-part fractures, who were admitted into our hospital from Mar. 2010 to Apr. 2012. Twenty-seven Patients who were treated with MIPPO and LPHP were taken as the MIPPO group ,and twenty-one patients who were treated with ORIF（ open reduction with internal fixation ） and LPHP were taken as the ORIF group. Intra-operative fracture healing time, hospital stay, functional recovery and complications were compared between the two groups and statistical analysis was performed. Results To- tally 48 patients were followed up for 12 to 24 months（ mean 15.3 months）. MIPPO combined with LPHP in the treat- ment of proximal humerus fractures can obtain good effects. There was statistical difference in regard to the mean inci- sion length, operation time, blood loss, hospital day and fracture healing time in both groups. Better functional recovery and fewer complication rate were observed in the MIPPO group, but without statistically significant difference （P 〉 0. 05 ）. Conclusion MIPPO combined with LPHP in the treatment of proximal humerus fractures meet the biological fixation principles ,which is an appropriate approach for treating proximal humeral two-part/three-part fractures.