正骨手法结合MIPPO技术重建肱骨近骨折端内侧柱稳定的临床应用

目的：探讨正骨手法闭合复位结合经皮微创固定（MIPPO）重建肱骨近端骨折内侧柱稳定的临床研究。方法：采用正骨手法闭合复位结合经皮锁定钢板固定重建肱骨内侧柱稳定治疗肱骨近端骨折34例。记录术后3、6、12个月骨折恢复情况，内固定是否松动断裂，肱骨头有无缺血坏死，内固定取出时间和内固定取出后局部骨质情况以及有无再骨折。术后应用Constant-Murley评分系统对肩关节进行评定。结果：术后所有患者切口均愈合并获随访，时间8~21个月，平均16.7个月。1例患者术后出现腋神经损伤症状，6个月后症状消失；1例患者术后2个月出现肱骨头内翻畸形，但螺钉尚在肱骨头内，未予翻修，骨折畸形愈合，术后12个月拆除内固定，肩外展功能受限明显；1例患者术后1年出现肱骨头缺血性坏死，二期拆除内固定，行肱骨头置换；余患者术后6~9个月骨性愈合，摄片复查骨皮质连续，重塑良好。总分比较：3个月与6个月比较，P＜0.05，差异有统计学意义。术后12个月根据Constant-Murley评分，总分75~88分，良21例，中13例。结论：正骨手法整复经皮微创锁定钢板固定治疗肱骨近端骨折，重建内侧柱稳定，具有创伤小、血循破坏少、固定可靠等优点，是治疗肱骨近端骨折的有效方法。

Intraoperative Technique Combined with MIPPO in the Treatment of Fractures of the Proximal Humerus with Locking Plate Fixation

Objective: To investigate the clinical effects of intraoperative technique with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique in the treatment of proximal humerus fractures. Methods: From Jan 2012 to July 2015, 34 patients with proximal humerus fractures were treated with intraoperative technique and locking plate osteosynthesis to rebuilt the lateral column stability. At the 3rd, 6th and 12th months after operation, recorded the recovery of the fracture, and whether fracture fixation was loose and whether ischemic necrosis of the humeral head was present. The removing time of internal fixation and the local fractures after removing internal fixation were also observed, so did re-fracture. The function of the shoulder was assessed by Constant-Murley Score. Results: 34 cases were followed up 8~21 months (averaged 16.7 months), 1 case was found axillary nerve injury and the symptoms disappeared in 6 months. 1 case was found varus deformity in the humeral head, 1 caes developed ischemic necrosis of the humeral head; the others were cured in 6~9 months; Constant-Murley scores were significantly different between the 3rd month and the 6th month. In the end, 21 cases were excellent, 11 cases were good and 2 cases were normal according to the scores. Conclusion: The technique of intraoperative technique combined with MIPPO to rebuild the lateral column stability has the advantages of less blood loss, rapid recovery, less vascular damage and reliable fixation etc. It can effectively treat the proximal humerus fracture.