MIPPO与ORIF治疗Neer Ⅱ型老年肱骨近端骨折病例对照研究
|
摘要
目的 :比较经皮微创接骨板内固定术(MIPPO)与切开复位内固定术(ORIF)两种术式治疗NeerⅡ型老年性肱骨近端骨折的临床疗效。方法:回顾性分析2014年3月至2016年3月分别采用MIPPO与ORIF手术治疗的NeerⅡ型老年性肱骨近端骨折46例患者,其中MIPPO组20例,男9例,女11例,年龄65~80(70.4±4.4)岁;ORIF组26例,男11例,女15例,年龄65~79(70.9±4.0)岁。比较两组术中透视次数,住院时间,骨折愈合时间,术后康复锻炼启动时间,术后3、6、12个月肩关节功能Constant-Murley评分,末次随访关节功能分级及腋神经损伤等并发症情况。结果:46例患者均获随访,时间12~24(16.8±3.7)个月。Mippo组骨折愈合时间(13.0±0.8)周较ORIF组(13.8±1.4)周短,康复锻炼启动时间(3.0±0.9)d较ORIF组(6.8±1.3)d短,术中透视次数(19.2±3.7)次较ORIF组(12.1±3.4)次多。术后3、6个月Constant-Murley肩关节功能评分81.3±3.9和86.6±5.4均高于ORIF组69.5±6.6和80.5±6.7。但两组住院时间、术后12个月Constant Murley肩关节功能评分及末次关节功能分级差异均无统计学意义;MIPPO组有1例腋神经损伤,ORIF组有2例延迟愈合,两组各有1例复位丢失,均无感染、内固定断裂等。结论:MIPPO与ORIF均能治疗NeerⅡ型老年性肱骨近端骨折,前者具有术后恢复更快、康复锻炼更早、早期肩关节功能恢复好等优点,但存在腋神经损伤、X线暴露多等缺点。
Objective:To compare the clinical efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)and open reduction and internal fixation(ORIF) in treating senile NEERⅡproximal humerus fractures. Methods:From March2014 to March 2016,46 elderly patients with NeerⅡproximal humerus fractures were retrospectively reviewed. Among them,20 patients in MIPPO group included 9 males and 11 females with an average age of(70.4±4.4) years old; while 26 patients in ORIF group included 11 males and 15 females with an average age of(70.9±4.0) years old. The length of hospital stay,times of fluoroscopy,beginning time of function rehabilitation,healing time of fracture,Constant Murley score of the shoulder joint at3,6,12 months after operation and complications were observed and compared. Results:All patients were followed up for 12 to24 months with an average of 16.8±3.7. The healing time of fracture,beginning time of function rehabilitation in MIPPO group were(13.0±0.8) weeks,(3.0±0.9) days respectively and shorter than those in ORIF group which were(13.8±1.4) weeks and(6.8±1.3) days. The times of fluoroscopy in MIPPO group was 19.2±3.7 and more than that in ORIF group which was 12.1±3.4.At 3 and 6 months after operation,Constant Murley score in MIPPO group were 81.3±3.9,86.6±5.4 and more than that in ORIF group which were 69.5 ±6.6,80.5 ±6.7. There were no differences between two groups in the length of hospital stay,Constant Murley score at 12 months after operation and grading at the final follow-up. There was one fracture redisplacement in each group. And 1 case of axillary nerve injury in MIPPO group,2 cases of delayed union in ORIF group. No incision infection,screw loosening or plate break was found. Conclusion:MIPPO and ORIF are both effective in treating Neer Ⅱ proximal humeral fractures. MIPPO technique has the advantages of faster recovery,earlier rehabilitative exercise and better shoulder function. The disadvantages are more exposure to radiationd and the possibility of axillary nerve injure.
Objective:To compare the clinical efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)and open reduction and internal fixation(ORIF) in treating senile NEERⅡproximal humerus fractures. Methods:From March2014 to March 2016,46 elderly patients with NeerⅡproximal humerus fractures were retrospectively reviewed. Among them,20 patients in MIPPO group included 9 males and 11 females with an average age of(70.4±4.4) years old; while 26 patients in ORIF group included 11 males and 15 females with an average age of(70.9±4.0) years old. The length of hospital stay,times of fluoroscopy,beginning time of function rehabilitation,healing time of fracture,Constant Murley score of the shoulder joint at3,6,12 months after operation and complications were observed and compared. Results:All patients were followed up for 12 to24 months with an average of 16.8±3.7. The healing time of fracture,beginning time of function rehabilitation in MIPPO group were(13.0±0.8) weeks,(3.0±0.9) days respectively and shorter than those in ORIF group which were(13.8±1.4) weeks and(6.8±1.3) days. The times of fluoroscopy in MIPPO group was 19.2±3.7 and more than that in ORIF group which was 12.1±3.4.At 3 and 6 months after operation,Constant Murley score in MIPPO group were 81.3±3.9,86.6±5.4 and more than that in ORIF group which were 69.5 ±6.6,80.5 ±6.7. There were no differences between two groups in the length of hospital stay,Constant Murley score at 12 months after operation and grading at the final follow-up. There was one fracture redisplacement in each group. And 1 case of axillary nerve injury in MIPPO group,2 cases of delayed union in ORIF group. No incision infection,screw loosening or plate break was found. Conclusion:MIPPO and ORIF are both effective in treating Neer Ⅱ proximal humeral fractures. MIPPO technique has the advantages of faster recovery,earlier rehabilitative exercise and better shoulder function. The disadvantages are more exposure to radiationd and the possibility of axillary nerve injure.
引文
[1]王蕾.肱骨近端骨折的治疗理念与思考[J].中国骨伤,2013,26(1):1-3.WANG L.Therapy conception and thinking of proximal humeral fractures[J].Zhongguo Gu Shang/China J Orthop Trauma,2013,26(1):1-3.Chinese.
[2]Bergdahl C,Ekholm C,Wennergren,et al.Epidemiology and patho-anatomical pattern of 2 011 humeral fractures:data from the Swedish Fracture Register[J].BMC Musculoskelet Disord,2016,17:159.
[3]Murray IR,Amin AK,White TO,et al.Proximal humeral fractures:current eoncepts in classification,treatment and outcomes[J].Bone Joint Surg Br,2011,93(1):1-11.
[4]Sohn HS,Shin SJ.Minimally invasive plate osteosynthesis for proximal humeral fractures:clinical and radiologic outcomes according to fracture type[J].J Shoulder Elbow Surg,2014,23(9):1334-1340.
[5]Neer CS 2nd.Displaced proximal humeral fractures.PartⅠ.Classification and evaluation[J].J Bone Joint Surg Am,1970,52(6):1077-1089.
[6]Spross C,Platz A,Rufibach K,et al.The PHILOS plate for proximal humeral fractures-risk factors for complications at one year[J].J Trauma Acute Care Surg,2012,72(3):783-792.
[7]宋正鑫,刘岩,毛英夫,等.肩峰下前外侧入路治疗肱骨近端2或3部分骨折病例对照研究[J].中国骨伤,2017,30(3):227-232.SONG ZX,LIU Y,MAO YF,et al.Anterolateral acromial approach for the treatment of proximal humerus in 2-or 3-part fractures-a case control study[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(3):227-232.Chinese with abstract in English.
[8]Jung WB,Moon ES,Kis SK,et al.Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate[J].BMC Musculoskelet Disord,2013,(14):102.
[9]郭秀武,樊健,袁锋.内侧柱是否使用螺钉支撑对锁定钢板治疗肱骨近端骨折的疗效比较[J].中国骨伤,2016,29(6):509-512.GUO XW,FAN J,YUAN F.Comparison of clinical effect on locking plate for proximal humeral fracture with or without application of inferomedial screws[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(6):509-512.Chinese with abstract in English.
[10]Caforio M,Maniscalco P.The importance of early rehabilitation in proximal humeral fracture:A clinical trial of efficacy and safety of a new endomedullary nail[J].J Back Musculoskelet Rehabil,2017,30(2):195-202.
[11]陈启明,季烈峰,潘志军,等.肩峰前外侧入路与胸大肌三角肌入路治疗肱骨近端Neer 2、3部分骨折的病例对照研究[J].中国骨伤,2014,27(12):991-994.CHEN QM,JI LF,PAN ZJ,et al.Treating Neer two-and threepart of proximal humeral fractures through anterolateral acromial approach and deltopectoral approach[J].Zhongguo Gu Shang/China J Orthop Trauma,2014,27(12):991-994.Chinese with abstract in English.
[12]Koljonen PA,Fang C,Lau TW,et al.Minimally invasive plate osteosynthesis for proximal humeral fractures[J]J Orthop Surg(Hong Kong),2015,23(2):160-163.
[13]Acklin YP,Stoffel K,Sommer C.A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures[J].Injury,2013,44(4):456-460.
[14]Gonc U,Atabek M,Teker K,et al.Minimally invasive plate osteosynthesis with PHILOS plate for proximal humerus fractures[J].Acta Orthop Traumatol Turc,2017,51(1):17-22.
[15]Cheung S,Fitzpatrick M,Lee TQ,et al.Effects of shoulder position on axillary nerve positions during the split lateral deltoid approach[J].J Shoulder Elbow Surg,2009,18(5):748-755.
[16]Traver JL,Guzman MA,Cannada LK,et al.Is the axillary nerve at risk during a deltoid-splitting approach for proximal humerus fractures[J].J Orthop Trauma,2016,30(5):240-244.
[17]Westphal T,Woischnik S,Adolf D,et al.Axillary nerve lesions after open reduction and internal fixation of proximal humeral fractures through an extended lateral deltoid-split approach:electrophysiological findings[J].J Shoulder Elbow Surg,2017,26(3):464-471.
[2]Bergdahl C,Ekholm C,Wennergren,et al.Epidemiology and patho-anatomical pattern of 2 011 humeral fractures:data from the Swedish Fracture Register[J].BMC Musculoskelet Disord,2016,17:159.
[3]Murray IR,Amin AK,White TO,et al.Proximal humeral fractures:current eoncepts in classification,treatment and outcomes[J].Bone Joint Surg Br,2011,93(1):1-11.
[4]Sohn HS,Shin SJ.Minimally invasive plate osteosynthesis for proximal humeral fractures:clinical and radiologic outcomes according to fracture type[J].J Shoulder Elbow Surg,2014,23(9):1334-1340.
[5]Neer CS 2nd.Displaced proximal humeral fractures.PartⅠ.Classification and evaluation[J].J Bone Joint Surg Am,1970,52(6):1077-1089.
[6]Spross C,Platz A,Rufibach K,et al.The PHILOS plate for proximal humeral fractures-risk factors for complications at one year[J].J Trauma Acute Care Surg,2012,72(3):783-792.
[7]宋正鑫,刘岩,毛英夫,等.肩峰下前外侧入路治疗肱骨近端2或3部分骨折病例对照研究[J].中国骨伤,2017,30(3):227-232.SONG ZX,LIU Y,MAO YF,et al.Anterolateral acromial approach for the treatment of proximal humerus in 2-or 3-part fractures-a case control study[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(3):227-232.Chinese with abstract in English.
[8]Jung WB,Moon ES,Kis SK,et al.Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate[J].BMC Musculoskelet Disord,2013,(14):102.
[9]郭秀武,樊健,袁锋.内侧柱是否使用螺钉支撑对锁定钢板治疗肱骨近端骨折的疗效比较[J].中国骨伤,2016,29(6):509-512.GUO XW,FAN J,YUAN F.Comparison of clinical effect on locking plate for proximal humeral fracture with or without application of inferomedial screws[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(6):509-512.Chinese with abstract in English.
[10]Caforio M,Maniscalco P.The importance of early rehabilitation in proximal humeral fracture:A clinical trial of efficacy and safety of a new endomedullary nail[J].J Back Musculoskelet Rehabil,2017,30(2):195-202.
[11]陈启明,季烈峰,潘志军,等.肩峰前外侧入路与胸大肌三角肌入路治疗肱骨近端Neer 2、3部分骨折的病例对照研究[J].中国骨伤,2014,27(12):991-994.CHEN QM,JI LF,PAN ZJ,et al.Treating Neer two-and threepart of proximal humeral fractures through anterolateral acromial approach and deltopectoral approach[J].Zhongguo Gu Shang/China J Orthop Trauma,2014,27(12):991-994.Chinese with abstract in English.
[12]Koljonen PA,Fang C,Lau TW,et al.Minimally invasive plate osteosynthesis for proximal humeral fractures[J]J Orthop Surg(Hong Kong),2015,23(2):160-163.
[13]Acklin YP,Stoffel K,Sommer C.A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures[J].Injury,2013,44(4):456-460.
[14]Gonc U,Atabek M,Teker K,et al.Minimally invasive plate osteosynthesis with PHILOS plate for proximal humerus fractures[J].Acta Orthop Traumatol Turc,2017,51(1):17-22.
[15]Cheung S,Fitzpatrick M,Lee TQ,et al.Effects of shoulder position on axillary nerve positions during the split lateral deltoid approach[J].J Shoulder Elbow Surg,2009,18(5):748-755.
[16]Traver JL,Guzman MA,Cannada LK,et al.Is the axillary nerve at risk during a deltoid-splitting approach for proximal humerus fractures[J].J Orthop Trauma,2016,30(5):240-244.
[17]Westphal T,Woischnik S,Adolf D,et al.Axillary nerve lesions after open reduction and internal fixation of proximal humeral fractures through an extended lateral deltoid-split approach:electrophysiological findings[J].J Shoulder Elbow Surg,2017,26(3):464-471.