手法闭合复位微创经皮钢板固定治疗肱骨近端骨折的疗效观察

【目的】探讨手法闭合复位微创经皮钢板固定（MIPPO ）治疗肱骨近端骨折的疗效。【方法】选择肱骨近端骨折患者60例，随机分为两组，每组30例。观察组采用 MIPPO 治疗；对照组采用常规手术切口，复位内固定治疗。比较两组患者手术时间、术中出血量、切口大小、术后3个月 X 线骨折复位情况、术后12个月并发症的发生率及肩关节 Neer 评分。【结果】观察组患者手术时间为（50．6±9．7） min ，明显短于对照组（71．9±9．2）min ；观察组术中出血量为（149．7±37．1） mL ，明显少于对照组（245．4±46．1）mL ；观察组切口直径为（7．8±0．7）cm ，明显小于对照组（15．2±1．4）cm 。观察组患者术后优良率为93．3％（28／30），显著高于对照组80．0％（24／30），其差异均有统计学意义（均 P ＜0．05）。观察组患者术后12个月均未发现肱骨头坏死、腋神经损伤等情况，骨折均愈合；对照组患者术后12个月均未发现肱骨头坏死情况，但有1例腋神经损伤，骨折均愈合。【结论】MIPPO 治疗肱骨近端骨折比传统常规切开复位内固定手术，手术时间短、术中出血量少、切口小、复位良好、并发症少，值得临床推广应用。

Curative effect of Minimally Invasive Percutaneous Plate Osteosynthesis on Proximal Humeral Fractures with Closed Reduction

Objective]To investigate the therapeutic effect of closed reduction and minimally invasive per‐cutaneous plate osteosynthesis (MIPPO) in the treatment of proximal humeral fractures .Methods]Sixty cases of proximal humeral fractures were randomly divided into two groups ,30 cases in each group .The observation group was treated with MIPPO ;the control group was treated with routine operation incision and internal fixa‐tion .The operation time ,blood loss ,incision size ,and X‐ray fracture reduction in 3 months after operation , incidence of complications 12 months after operation and the Neer score of shoulder joint were compared be‐tween the two groups .Results]The operation time of the observation group was (50 .6 ± 9 .7) min ,which was significantly shorter than that of the control group (71 .9 ± 9 .2) min ;The amount of bleeding in the observa‐tion group was (149 .7 ± 37 .1) mL ,which was significantly less than that of the control group (245 .4 ± 46 .1) mL ;The incision diameter of the observation group was (7 .8 ± 0 .7) cm ,significantly smaller than that of the control group (15 .2 ± 1 .4) cm .The postoperative excellent rate of observation group was 93 .3% (28/30) ,sig‐nificantly higher than the control group 80% (24/30) ,the difference was statistically significant (mean P <0 .05) .In the observation group ,12 months after surgery ,no necrosis of the humeral head and axillary nerve injury were found ;in the control group ,no necrosis of the humeral head was found in 12 months after opera‐tion ,but there was only 1 case with axillary nerve injury ,and all the fractures healed .Conclusion]Compared with the conventional open reduction and internal fixation ,MIPPO treatment of proximal humerus fractures has the advantages of shorter operation time ,less blood loss ,smaller incision ,better reduction and fewer complications .It is worth of clinical application .