摘要
目的探讨经三角肌微创入路经皮微创锁定钢板(MIPO)技术治疗肱骨近端骨折的临床效果及对Constant-Murley肩关节评分量表(CMS)评分、凝血功能的影响。方法选取2022年1月至2024年12月收治的108例肱骨近端骨折患者,按随机数字表法分为观察组和对照组各54例,对照组行传统入路锁定钢板内固定术,观察组行经三角肌微创入路MIPO技术。比较两组术中及术后情况;比较两组凝血功能指标[纤维蛋白原(FIB)、D-二聚体(D-D)、纤维蛋白原降解产物(FDP)]、骨折愈合相关因子[胰岛素生长因子-1(IGF-1)、骨形成蛋白-2(BMP-2)、骨特异性碱性磷酸酶(BALP)]、CMS及疼痛视觉模拟评分法(VAS)评分;统计两组并发症发生情况。结果观察组术中出血量少于对照组,手术、住院及骨折愈合时间短于对照组,并发症总发生率低于对照组(P<0.05,P<0.01);术后3 d,观察组血浆FIB、D-D、FDP低于对照组(P<0.05);术后3个月观察组血清IGF-1、BMP-2、BALP水平及CMS评分高于对照组,疼痛VAS评分低于对照组(P<0.05)。结论经三角肌微创入路MIPO技术治疗肱骨近端骨折可减小对骨折血运的影响,缩短骨折愈合时间,缓解疼痛,改善肩关节功能,且并发症少。
Objective To investigate the clinical effect of minimally invasive plate osteosynthesis(MIPO)technique via a deltoid-splitting approach on proximal humeral fractures(PHF)and its impact on Constant-Murley Shoulder Score(CMS),and coagulation function.Methods A total of 108 patients with PHF admitted from January 2022 to December 2024 were selected and divided into the observation group(n=54)and the control group(n=54)according to the random number table method.The control group was treated with traditional approach locking plate internal fixation,and the observation group was treated with MIPO technique via a deltoid-splitting approach.The intraoperative and postoperative conditions were compared between the two groups.The coagulation function indexes[fibrinogen(FIB),D-dimer(D-D),fibrinogen degradation products(FDP)],fracture healing-related factors[insulin growth factor-1(IGF-1),bone morphogenetic protein 2(BMP-2),bone specific alkaline phosphatase(BALP)],CMS and visual analogue scale(VAS)pain scores were compared between the two groups.In addition,the incidence of complications was recorded.Results The intraoperative blood loss in the observation group was less than that in the control group,the duration of operation,length of hospitalization and fracture healing time were shorter than those in the control group,and the total incidence of complications was lower than that in the control group(P<0.01).At 3 d after operation,plasma FIB,D-D and FDP in the observation group were lower than those in the control group(P<0.05).At 3 months after operation,the serum IGF-1,BMP-2,BALP and CMS scores of the observation group were higher than those of the control group,while the VAS pain score was lower than that of the control group(P<0.05).Conclusion The MIPO technique via a deltoid-splitting approach for the treatment of PHF can reduce the impact on blood circulation of the fracture,shorten the fracture healing time,alleviate pain,and improve shoulder joint function,with fewer complications.
作者
徐育生
蔡煜林
苏先喆
XU Yusheng;CAI Yulin;SU Xianzhe(Department of Trauma and Orthopedics,Shantou Hospital of Traditional Chinese Medicine,Shantou,Guangdong 515000,China)
出处
《临床误诊误治》
2025年第24期89-95,104,共8页
Clinical Misdiagnosis & Mistherapy
基金
汕头市科技计划医疗卫生类别项目(211115136494430)
广东省中医药局科研项目(20212217)。
