| Objective To retrospective the results about minimally insvasive percutaneous osteosynthesis (MIPO) and traditional shoulder joint anteromedial approach internal fixation to treat the proximal humeral fractures,to summary the trauma of operation and postoperative neurological function and the rate of complications, and reference to the choice of the proximal humeral fractures surgical approach.Methods 156 patients of proximal humeral fractures between September 2008 to October 2010 were analyzed retrospectively. A total of 46 cases of patients met the inclusion criteria and exclusion criteria according to NeerⅡtype (angled significantly, shift by), III type. They were randomized to divide into two groups:MIPO group (group A) 22 cases, the shoulder joint anteromedial approach group (group B) 24 cases. Group A:13 males and 9 females; the left side 13 cases, the right side 9 cases; aged 39-70 years, mean 55.36 years. Type of injury before surgery in 14 cases NeerⅡ,Ⅲtype 8 cases. Group B:14 males and 10 females; the left side 9 cases, the right side 15 cases; aged 32-79 years, mean 54.29 years. Type of injury before surgery in 15 cases NeerⅡ,Ⅲtype in 9 cases.Some of the patients received the arm washing prescription with chinese traditional medicine.Two groups clinical outcomes were assessed with the operation time,the intraoperative blood loss, total drainage postoperation 3 days, Creatine Kinase (CK) and its isoenzyme (CK-MB), Lactate Dehydrogenase (LDH), potassium ions (K+) indicators.We followed up for X-ray, VAS score, the rate of complications postoperations 1 year and functional scores (ASES score, Constant Score).Result In group A,the operative time was(96.14±8.70 min), the intraoperative blood loss was (255.45±104.55 ml),and the total drainage postoperation 3 days was (55.18■20.50 ml).the dates were (89.33±10.45 min), (407.42±171.99 ml), (96.17±31.35 ml) in group B which higher than group A.There were significantly different between the two groups (P<0.05). All patients tested blood CK and CK-MB postoperation 1 day,3day and a week.The dates indicated that group A were less than group B,and with statistical significance(p<0.05). All cases were followed up for 3 months to 1 years.The group A mean VAS score at the postoperation a week was significantly higher than group B.But there was no significant difference between two groups postoperation 3 month (P>0.05). There was a significant difference between the two groups postoperation 3 month about ASES score that group A were higher than group B, while no statistical significance in postoperation 6 month or 1 year. There was a statistical significance between group A and B in Constant Score postoperation 3 month and 6 month that group A were higher than group B also, but not postoperation 1 year. In 22 cases of group A, one patients appeared nonunion while a case of internal fixation loosened in group B. There were no serious complications related to internal fixation broken, no infection occurred. And the short-term efficacy of arm washing prescription with chinese traditional medicine was better than the control group.Conclusion Treatment of proximal humeral fractures with minimally insvasive percutaneous osteosynthesis are effective in decreased operatian trauma with rarely complications.The follow-up outcomes prompt a strong internal fixation and earlier joint activities.It is a safe and effective surgery treatment. Add the arm washing prescription with chinese traditional medicine to the postoperative convalesce sections can reduce pain and promote recovery of joint motion. |
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