Alberio Riccardo Luigi, Del Re Matteo, Grassi Federico Alberto
Department of Orthopedics and Traumatology, University of East Piedmont, Hospital "Maggiore della Carità", Via Mazzini 18, Novara, Italy.
Adv Orthop. 2018 Jun 3;2018:5904028. doi: 10.1155/2018/5904028. eCollection 2018.
The aim of this study was to evaluate the clinical and radiographic results after minimally invasive plate osteosynthesis (MIPO) for proximal humerus fractures. Potential advantages of this approach include the easier exposure of the greater tuberosity and the limited surgical dissection around the fracture site.
From October 2011 to March 2016, thirty-nine patients (32 women, 7 men) with a mean age of 64.9 years (range: 48-80) were surgically treated with the MIPO technique for proximal humeral fractures. According to Neer classification, there were 12 two-part, 24 three-part, and 2 four-part fractures and 1 two-part fracture-dislocation; the AO/OTA system was also used to categorize the fractures. The Constant-Murley (CMS) and the Oxford Shoulder (OSS) Scores were used to evaluate shoulder function.
Thirty-four patients were available for clinical and radiographic evaluation at a mean follow-up of 31.8 months (range: 12-54 months). All fractures healed and no postoperative complications occurred. Full recovery of pretrauma activities was reported by 27 patients, while 7 patients presented mild functional limitations. The mean absolute CMS was 75.2 (range: 55-95), the mean normalized CMS was 90.5 (range: 69-107), and the mean OSS was 43.7 (range: 31-48). The only statistically significant correlation was found between the female gender and lower absolute CMS and OSS. Radiographic evaluation revealed varus malunion in 4 cases and valgus malunion in 1 case, while incomplete greater tuberosity reduction was detected in 4 cases. All malunions were related to inadequate reduction at time of surgery and not to secondary displacement.
MIPO for proximal humeral fractures is an effective and safe surgical procedure. The limited tissue dissection allows minimizing the incidence of nonunion, avascular necrosis, and infection. The technique is not easy, requires experience to achieve mastery, and should be reserved for selected fracture patterns. In our experience, the main advantage of this approach consists in the direct access to the greater tuberosity, thus facilitating its anatomic reduction and fixation.
本研究旨在评估微创钢板接骨术（MIPO）治疗肱骨近端骨折后的临床及影像学结果。该方法的潜在优势包括更易于显露大结节以及骨折部位周围有限的手术剥离。
2011年10月至2016年3月，39例患者（32例女性，7例男性）接受了MIPO技术治疗肱骨近端骨折，平均年龄64.9岁（范围：48 - 80岁）。根据Neer分类，有12例两部分骨折、24例三部分骨折、2例四部分骨折和1例两部分骨折脱位；还使用AO/OTA系统对骨折进行分类。采用Constant-Murley（CMS）评分和牛津肩部（OSS）评分评估肩部功能。
34例患者可进行临床及影像学评估，平均随访31.8个月（范围：12 - 54个月）。所有骨折均愈合，未发生术后并发症。27例患者报告创伤前活动完全恢复，7例患者存在轻度功能受限。平均绝对CMS为75.2（范围：55 - 95），平均标准化CMS为90.5（范围：69 - 107），平均OSS为43.7（范围：31 - 48）。仅发现女性性别与较低的绝对CMS和OSS之间存在统计学显著相关性。影像学评估显示4例内翻畸形愈合、1例外翻畸形愈合，4例大结节复位不完全。所有畸形愈合均与手术时复位不充分有关，而非继发移位。
MIPO治疗肱骨近端骨折是一种有效且安全的手术方法。有限的组织剥离可使骨不连、缺血性坏死和感染的发生率降至最低。该技术并不容易，需要经验才能掌握，应仅用于特定的骨折类型。根据我们的经验，这种方法的主要优势在于可直接显露大结节，从而便于其解剖复位和固定。
