经皮微创锁定钢板内固定对老年肱骨近端骨折患者的临床疗效

目的探讨经皮微创锁定钢板内固定(MIPPO)对老年肱骨近端骨折患者疼痛程度及关节功能的影响。方法前瞻性选取2017年6月-2018年6月治疗的肱骨近端骨折患者105例,依据手术方法将其分为MIPPO组(n=55)和传统切开复位组(n=50),MIPPO组患者行微创锁定钢板改良内固定治疗,传统切开复位组患者行传统切开复位内固定治疗,比较两组患者围术期指标、治疗效果、治疗前后VAS评分及不良事件发生情况。结果MIPPO组患者手术时间(69.1±16.4)min vs.(101.4±30.5)min]、术中出血量(85.3±24.5)m L vs.(163.5±40.8)m L)]、术后引流量(18.3±4.6)m L vs.(23.4±5.3)m L]、住院时间(2.8±0.9)d vs.(4.5±1.0)d],骨折愈合时间(11.6±2.3)周vs.(16.8±3.5)周],可负重时间(8.1±2.1)周vs.(9.6±2.0)周]均短(少)于传统切开复位组,差异有统计学意义(P<0.05)。MIPPO组、传统切开复位组患者治疗有效率分别为94.55%、80.00%,MIPPO组优于传统切开复位组(P<0.05)。治疗前两组患者VAS评分比较差异无统计学意义(P>0.05);术后2、4周,MIPPO组患者VAS评分均低于传统切开复位组(P<0.05)。传统切开复位组患者术后3例发生骨折延迟愈合,2例发生外展受限;MIPPO组患者术后1例发生骨折延迟愈合,1例发生外展受限;两组患者不良事件发生率比较差异无统计学意义(10.00%vs.3.64%,χ^2=1.538,P=0.173)。结论微创锁定钢板改良内固定治疗老年肱骨近端骨折治疗效果显著,不增加不良事件发生风险,值得临床推广使用。

Effect of minimally invasive percutaneous plate osteosynthesis on pain degree and joint function in elderly patients with proximal humerus fracture

Objective To investigate the effect of minimally invasive percutaneous plate osteosynthesis(MIPPO)on the degree of pain and joint function in elderly patients with proximal humerus fractures.Methods Totally 105 patients with proximal humeral fractures were admitted into our hospital from Jun.2017 to Jun.2018.According to the operation method,they were divided into MIPPO group(n=55)and traditional open reduction group(n=50).Patients in the MIPPO group were given minimally invasive locking plate improved internal fixation,and patients in the traditional open reduction group were given traditional open reduction and internal fixation treatment.The perioperative indexes,therapeutic effect,VAS score before and after treatment and the occurrence of adverse events were compared between the two groups.Results For the MIPPO group,the operation time(69.1±16.4)min vs.(101.4±30.5)min],intraoperative bleeding volume(85.3±24.5)mL vs.(163.5±40.8)mL],postoperative drainage volume(18.3±4.6)mL vs.(23.4±5.3)mL],hospitalization time(2.8±0.9)days vs.(4.5±1.0)days],fracture healing time(11.6±2.3)weeks vs.(16.8±3.5)weeks],weight-bearing time(8.1±2.1)weeks vs.(9.6±2.0)weeks]were less than those in the traditional open reduction group,and the differences were statistically significant(P<0.05).The effective rates of the MIPPO group and traditional open reduction group were 94.55%and 80.00%,respectively,and the MIPPO group was superior to the traditional open reduction group(P<0.05).There was no significant difference in VAS score between the two groups before treatment(P>0.05).The VAS scores of patients in the MIPPO group were lower than those in the traditional open reduction group at 2 and 4 weeks after operation(P<0.05).In the traditional open reduction group,3 patients had delayed fracture healing and 2 patients had limited abduction.In the MIPPO group,1 patient suffered delayed fracture healing and 1 patient had limited abduction.There was no significant difference in the incidence of adverse events between the two groups(10.00%vs.3.64%,χ2=1.538,P=0.173).Conclusion The effect of minimally invasive locking plate modified internal fixation in the treatment of elderly proximal humerus fractures is significant,without increasing the risk of adverse events,and it is worthy of clinical promotion.