CAJ | 학술논문

目的探讨采用肱骨髓内钉、切开复位内固定术(ORIF)及经皮微创接骨板技术(MIPPO)3种方法治疗老年人肱骨近端二部分骨折的疗效. 方法回顾性分析2006年1月至2009年12月收治的49例肱骨近端二部分骨折患者资料,男12例,女37例；年龄54 ～71岁,平均65 7岁.其中采用肱骨髓内钉(髓内钉组)治疗18例,ORIF(ORIF组)治疗12例,MIPPO组(MIPPO组)治疗19例.对患者术前、术中情况、骨折愈合情况、并发症及功能恢复情况进行比较.结果 49例患者术后均获8～36个月(平均17.8个月)随访.髓内钉组、ORIF组及MIPPO组的切口平均长度分别为(7.1±0.3)cm、(13.7±0.9)cm、(12.1±0.8)cm;术中出血量平均分别为(58.3±20.7)mL、(283.3±44.4)mL、(96.3±9.0)mL；3组之间两两比较差异均有统计学意义(P＜0.05)；髓内钉组平均手术时间[(90.5±18.5) min]少于ORIF组[(111.3±16.7)min]和MIPPO组[(112.4±9.9) min],比较差异有统计学意义(P＜0.05)；3组之间骨折愈合时间、术后功能恢复优良率相当,比较差异无统计学意义(P＞0.05). 结论 3种方法治疗老年人肱骨近端二部分骨折均可获得较好效果,但髓内钉具有创伤小、手术时间短的优点,是一种较为合适的治疗方法.
목적 탐토채용굉골수내정、절개복위내고정술(ORIF)급경피미창접골판기술(MIPPO)3충방법치료노년인굉골근단이부분골절적료효. 방법 회고성분석2006년1월지2009년12월수치적49례굉골근단이부분골절환자자료,남12례,녀37례；년령54 ～71세,평균65 7세.기중채용굉골수내정(수내정조)치료18례,ORIF(ORIF조)치료12례,MIPPO조(MIPPO조)치료19례.대환자술전、술중정황、골절유합정황、병발증급공능회복정황진행비교.결과 49례환자술후균획8～36개월(평균17.8개월)수방.수내정조、ORIF조급MIPPO조적절구평균장도분별위(7.1±0.3)cm、(13.7±0.9)cm、(12.1±0.8)cm;술중출혈량평균분별위(58.3±20.7)mL、(283.3±44.4)mL、(96.3±9.0)mL；3조지간량량비교차이균유통계학의의(P＜0.05)；수내정조평균수술시간[(90.5±18.5) min]소우ORIF조[(111.3±16.7)min]화MIPPO조[(112.4±9.9) min],비교차이유통계학의의(P＜0.05)；3조지간골절유합시간、술후공능회복우량솔상당,비교차이무통계학의의(P＞0.05). 결론 3충방법치료노년인굉골근단이부분골절균가획득교호효과,단수내정구유창상소、수술시간단적우점,시일충교위합괄적치료방법.
Objective To compare humeral intramedullary nailing (HIN),open reduction and internal fixation (ORIF) and minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of two-part humeral proximal fractures in the elderly patients. Methods From January 2006 to December 2009,49 patients with fracture of humeral surgical neck were treated by HIN,ORIF and MIPPO.They were 12 men and 37 women,with an average age of 65.7 years (from 54 to 71 years).There were 18 cases in group A (HIN),12 in group B (ORIF) and 19 in group C (MIPPO).The preoperative conditions,fracture healing,complications and functional recovery were compared between the 3 methods. Results All the 49 patients were followed up for 8 to 36 months (average,17.8 months).The mean incision length was 7.1 ±0.3 cm in group A,13.7 ±0.9 cm in group B and 12.1 ±0.8 cm in group C; the mean operative blood loss was 58.3±20.7 mL in group A,283.3 ±44.4 mLin group B and 96.3±9.0 mL in group C.There were significant differences between the 3 methods(P ＜ 0.05).The HIN had the shortest incision and the least operative blood loss.In the mean operative time,HIN[(90.5 ± 18.5) min] was signifieandy better than ORIF [[( 111.3 ± 16.7 ) min] and MIPPO[( 112.4 ± 9.9) min] ( P ＜ 0.05).There were no significant differences in the fracture healing time and functional recovery between the 3 groups ( P ＞ 0.05 ). Conclusions Although the 3 methods can produce similar efficacy in the treatment of two-part humeral proximal fractures in the elderly patients,the humeral intramedullary nailing has an advantage over the other two in operative invasion and operative time.