MIPPO技术结合PILOS手术与急诊手法结合夹板治疗中老年人肱骨外科颈两部分骨折的对比研究

摘要

Objective:To investigate the feasibility and clinical efficacy of MIPPO technique combined with PILOS plate in the treatment of proximal humeral fractures.Methods:a retrospective analysis of 47 elderly patients who had two parts fractures of humerus surgical neck in our hospital from March 2012 to April 2015 with com plete follow-up data.22 cases were treated with MIPPO technique combined with PILOS plate.The clinical and radiographic evaluation was performed at 1st,2nd,3rd,6th,12th month after operation.The clinical evaluation was performed by the constant score of shoulder joint and the standard position of the humerus image was used to e valuate the fracture healing.25 cases of the same type of fracture were treated with emergency manual reduction and splint fixation.Results:all 47 patients were followed up within 1 year after treatment.Constant scores of the operation group were higher than the conservative treatment group at 1 st,2nd,3rd,6th,12th month after treatment,and the difference was statistically significant.The conservative treatment group had a constant score higher than 70 in 1 year after treatment,showing that the effect was still satisfying.There were no complications of axil lary nerve injury,vascular injury,loss of reduction,and nonunion in the operation group.Conclusion:MIPPO technique combined with PILOS plate,compared with the emergency manual reduction and splint fixation,in two parts fracture of humerus surgical neck of the elderly has the advantages of better and faster recovery at shoulder joint function,but the latter still has satisfactory curative effect.%目的 观察微创经皮钢板内固定(MIPPO)技术结合PILOS手术治疗肱骨近端骨折的可行性及临床疗效.方法 回顾分析本院自2012年3月至2015年4月具有完整随访资料的47例肱骨外科颈两部分骨折.手术组22例采用MIPPO技术结合PILOS手术.采用平卧位,取肩峰外侧小切口,长约4 cm,不超过肩峰下5 cm,钝性分开三角肌,采用克氏针辅助复位,潜行插入锁定钛板,近端用锁定螺钉予以固定,远端经皮固定2～3颗锁定螺钉.术后指导肩关节功能锻炼.术后1、2、3、6、12个月进行临床及影像学评估,临床评估采用肩关节Constant评分,肱骨标准位正侧位片评估骨折愈合情况.保守治疗组25例同类型骨折患者采取急诊手法复位夹板固定,其后指导功能锻炼,定时评估.结果 全部47例患者均在处理后1年内获得随访.手术组1、2、3、6、12个月Constant评分均高于保守治疗组,差异具有统计学意义(P＜0.05),手法复位夹板固定组处理后1年constant评分均高于70分,表明疗效仍然满意.手术组无腋神经损伤、血管损伤、复位丢失、骨不连、不愈合等并发症.结论 MIPPO技术结合PILOS手术相对于急诊手法结合夹板治疗中老年人肱骨外科颈两部分骨折具有肩关节功能恢复更快更好的优点,但后者仍然具有满意疗效..