两种手术入路结合锁定钢板治疗老年人肱骨近端骨折比较研究.docVIP

两种手术入路结合锁定钢板治疗老年人肱骨近端骨折的比较研究 　　[摘要] 目的 比较经外侧三角肌入路微创接骨板技术（MIPPO）和经三角肌胸大肌入路开放复位内固定术（ORIF）治疗老年人肱骨近端骨折的疗效。方法 该院老年性肱骨近端骨折109例患者，随机分为两组，MIPPO组61例，ORIF组48例，对比两组的手术时间，术中出血量，住院时间，并发症及功能恢复情况。结果 87例获得随访12～20个月，平均16.7个月。MIPPO组的手术时间（72.8±14.9）min，术中出血量（86.7±22.1）mL，住院时间（17.0±3.4）d，ORIF组的手术时间（116.4±11.4）min，术中出血量（213.4±36.5）mL，住院时间（25.4±5.1）d，两组比较差异有统计学意义（P0.05）。结论 采用MIPPO技术治疗老年肱骨近端骨折，疗效确切，并发症少，术后功能恢复好，值得临床肯定与推广。 　　[关键词] 老年；肱骨；骨折经皮微创接骨板技术；切开内固定术 　　[中图分类号] R687.3 [文献标识码] A [文章编号] 1674-0742（2014）11（c）-0048-02 　　[Abstract] Objective To compare the effect between minimally invasive percutaneous plate osteosynthesis （MIPPO） via lateral deltoid splitting approach and open reduction and internal fixation（ORIF） via deltopectoral approach in the treatment of humeral proximal fractures in the elderly. Methods 109 elderly patients with humeral proximal fracture treated in our hospital were randomly divided into two groups， 61 cases in the MIPPO group， and 48 cases in the ORIF group. The duration of operation， intraoperative blood loss， length of stay， complications and functional recovery were compared between the two groups. Results 87 patients were followed up for 12 to 20 months with an average of 16.7 months. The duration of operation， intraoperative blood loss， length of stay of the MIPPO group was 72.8±14.9 min， 86.7±22.1ml， 17.0±3.4d， respectively， and that of the ORIF group was 116.4±11.4min， 213.4±36.5ml， 25.4±5.1d， respectively， the differences between the two groups were statistically significant （P0.05）. Conclusion For the treatment of humeral proximal fractures in the elderly， MIPPO has definite effect with less complications and better functional recovery， so it is worth the clinical affirmation and promotion. 　　[Key words] The elderly； Humerus； MIPPO for fractures； ORIF 　　随着社会老龄化，老年人肱骨近端骨折的发生率也呈上升趋势。然而老年人群常合并多种内科疾病，对手术创伤，失血耐受力低，手术治疗一直是比较棘手的问题。该研究自2008年1月―2012年12月间采用经三角肌胸大肌入路锁定钢板开放复位内固定术（open reduction and internal fixation， ORIF）与经三角肌外侧入路结合经皮微创内固定术（minimally invasive p