应用MIPO技术经肩峰前外侧入路治疗肱骨近端骨折的疗效观察【摘要】目的:评价应用微创钢板接#（minimallyinvasiveplateosteosynthesis,MIPO）技术肱骨近端内锁定系统（ProximalHumeralInternalLockingSystem,PHILOS）钢板经肩峰前外侧入路治疗肱骨近端骨折的临床疗效。方法：选取2012年4月-2014年3月应用MT卩0技术PHILOS钢板经肩峰前外侧入路治疗的38例肱骨近端骨折患者，其中男20例，女18例；年龄27〜82岁，平均62.2岁；伤后手术时间2〜17d,平均4.7d；Neer二部分骨折12例，三部分骨折19例，四部分骨折7例。自肩峰前0.5cm处向下切开皮肤，长约6cm,沿肌纤维方向劈开三角肌,显露骨折，直视下间接复位骨折，用克氏针临时固定，在肌层深面向远端插入PHILOS钢板，近端软组织手术窗用5~6枚锁定螺钉固定肱骨头，下方软组织手术窗植入3〜4枚螺钉固定肱骨干。结果：本组病例手术时间45〜110min,平均75min；术中出血60〜155inL,平均95inL；切口均一期愈合。38例得到平均9.3个月（6~18个月）的随访，骨折均愈合，愈合时间15.2周（11〜29周）。术后一年内，肩关节Neer评分优090分）19例，良（80〜89分）15例，可（71〜79分）3例，差（W70分）1例，优良率为89.5%o结论：应用MIPO技术PHTLOS钢板经肩峰前外侧入路治疗肱骨近端骨折具有创伤小、术中出血少、手术时间短、骨折愈合快、肩关节功能恢复好等优点。手术过程中必须对腋神经加以保护。该术式是治疗肱骨近端骨折的一种较好的方法，但与常规的经胸人肌三角肌间隙入路相比，如要明确哪种入路更为优良，则需要进一步增加患者数量来进行比较研究。【关键词】微创钢板接骨术；肩峰前外侧入路；肱骨近端骨折；肱骨近端内锁定系统钢板CurativeeffectObservationofUsingMinimalInvasivePlateOsteosynthesisTechniquethroughAnterolateralAcromialApproachfortheTreatmentofProximalHumeralFractures/CHENXiao-jun,XIAOJi-chong,ZOUYong-gen,etal.//MedicalInnovationofChina,2015,12(24)：136-140【Abstract]Objective：Toinvestigatethecurativeeffectofusingminimallyinvasiveplateosteosynthesis(MTPO)techniquethroughanterolateralacromialapproachforthetreatment,ofproximalhumerusfractureswithproximalhumeralinternallockingsystem(PHILOS)plate.Method：FromApr订2012toMarch2014,38casesofproximalhumerusfracturesweretreatedwithMIPOtechniquethroughanterolateralacromialapproachwith卩HTLOSplate.Therewere20malesand18females,andtheaverageagewas62.2years(range27-82years)andtheaveragetimewas4.7days(range,2-17days)betweeninjuryandoperation,including12casesofNeerII,19casesofNeerIILand7casesofNeerIV.Startingfrom0.5cmanteriortotheacromion,theskinwasincisedfrom6cminlengthandthedeltoidmusclewasseparatedalongthemusclefiberstoexposethefracturefragments.UnderdirectvisiontheindirectreductionofthefracturewasperformedandthefragmentsweretemporarilyfixedwithK~wires.The卩HTLOSplatewasinserteddistallybeneaththedeltoidmuscleandthepositionbetweenthedistalplateandthehumeralshaftwasadjustedthroughanothersmal1skinincisiononthelateralupperarm.5~6lockingscrewswereinsertedtotheproximalplatetofixthefracturefragmentswhile3-4screwswereinsertedtothedistalplatetofixittothehumeralshaft.Result：Thisseriesexperiencedaprimarywoundhealing,ameanoperationtimewas75min(range,45一110min),andameanintraoperativebloodlosswas95mL(range60-155mL).Allthe38caseswerefolloweduprangingfrom6to18monthswithanaverageof9.3months.Thebonehealingtimewas15.2weeks(range11-29weeks)・Thefunctionalresultsoftheshoulder,accordingtoNeerscoreswasevaluatedwithin1yearafteroperation,wereclassifiedasexcellentin19cases,goodin15cases,fairin3cases,andpoorin1case,theexcellentandgoodratewas89.5%.Conclusion：UsingMTPOtechniquethroughanterolateralacromialapproachforthetreatmentofproxim...