微創鎖定接骨板治療對肱骨近端骨折肩關節功能的影響

王守赟+阮文禮++馮殿鵬

[摘要] 目的 觀察微創鎖定接骨板治療對肱骨近端骨折肩關節功能的影響。 方法 回顧性分析2015年6月～2016年6月大連市第二人民醫院收治的外傷性肱骨近端骨折63例患者的臨床資料，根據手術方法不同分為微創組（31例），傳統組（32例）。微創組采用微創鎖定接骨板內固定術，傳統組采用傳統切開復位內固定術。比較兩組患者一般情況（包括手術時間、術中出血量、住院時間）、疼痛、肩關節功能恢復情況、患者滿意度及不良事件發生情況進。 結果 微創組手術時間、住院時間短于傳統組，術中出血量少于傳統組（P < 0.05）。術后7 d微創組VAS評分低于傳統組（P < 0.05）。術后3、6個月兩組VAS評分比較，差異無統計學意義（P > 0.05）。術后15 d微創組Neer肩關節功能評分優良率高于傳統組（P < 0.05），術后3、6個月兩組Neer肩關節功能評分優良率差異無統計學意義（P > 0.05）。微創組滿意度高于傳統組（P < 0.05）。兩組均發生嚴重不良事件。 結論 與傳統切開復位內固定術相比，微創鎖定接骨板治療肱骨近端骨折手術時間短、出血量少、住院時間短，早期即可恢復肩關節功能，且疼痛較輕，患者滿意度高。

[關鍵詞] 微創鎖定接骨板內固定術；切開復位內固定術；肱骨近端骨折；肩關節

[中圖分類號] R683 [文獻標識碼] A [文章編號] 1673-7210（2017）11（c）-0098-05

Effects of minimally invasive percutaneous osteosynthesis on shoulder function of proximal humeral fractures

WANG Shouyun RUAN Wenli FENG Dianpeng

Department of Orthopaedics， the Second People′s Hospital of Dalian City， Liaoning Province， Dalian 116011， China

[Abstract] Objective To explore the effects of minimally invasive percutaneous osteosynthesis on shoulder function of proximal humeral fractures. Methods A total of 63 clinical data of patients with proximal humeral fractures treated in the Second People′s Hospital of Dalian City from June 2015 to June 2016 were reviewed retrospectively and divided into the minimally invasive group （31 cases） and the traditional invasive group （32 cases） according to the different operation methods. The minimally invasive group was treated with minimally invasive percutaneous osteosynthesis and the traditional invasive group was treated with open reduction and internal fixation. The general situation （including operation time， intraoperative blood loss， hospital stays）， pain degree， the recovery of shoulder function， patients′ satisfaction and the adverse reactions were compared between the two groups. Results The operation time， intraoperative blood loss， hospital stays in the minimally invasive group were shorter or less than those of the traditional invasive group （P < 0.05）. After 7 d operation， the VAS score of the minimally invasive group was lower than that of traditional invasive group （P < 0.05）. There were no significant differences in VAS scores between the two groups in 3， 6 months after operation （P > 0.05）. After 15 d operation， the excellent and good rate of Neer shoulder function score of minimally invasive group was higher than that of the traditional invasive group （P < 0.05）. There were no significant differences in excellent and good rate of Neer shoulder function score between the two groups in 3， 6 months after operation （P > 0.05）. The patients′ satisfaction in the minimally invasive group was higher than that of traditional invasive group （P < 0.05）. Conclusion Compared with open reduction and internal fixation， minimally invasive percutaneous osteosynthesis in the treatment of proximal humeral fractures has shorter operation time and hospital stays， less intraoperative blood loss， faster shoulder function recovery， less pain and higher patients′ satisfaction.endprint

[Key words] Minimally invasive percutaneous osteosynthesis； Open reduction and internal fixation； Proximal humeral fractures； Shoulder function

臨床中肱骨骨折是較為常見的骨折類型，占所有肱骨骨折的45%，女性發生率高于男性，男女比例約為3∶7[1]。肱骨近端骨折是指肱骨外科頸以下2.0 cm左右與肱骨頭關節面之間的骨折。肱骨近端骨折大部分由外傷引起，多見于骨質疏松患者。隨著社會老齡化，老年人口增多，骨質疏松患者增多，肱骨骨折發生率大幅增高，引起臨床關注。肱骨近端骨折的治療受多種因素影響，治療手段多樣，包括肱骨近端髓內釘、接骨板固定、人工關節置換等，但均有復位失敗、畸形愈合等不良事件報道，臨床中尋找一種可靠的肱骨近端骨折治療方法迫在眉睫[2-3]。微創鎖定接骨板是近年逐漸應用于臨床的肱骨近端骨折治療方法，一方面鎖定接骨板為肱骨近端骨折提供了堅強內固定；……