陈磊

[摘要] 目的 探討微创手术方法治疗老年四肢骨折的临床治疗效果及对肢体功能的影响。 方法 选取2012年12月～2015年12月我院收治老年四肢骨折患者220例作为研究对象，根据随机数字表法分为对照组（n=110）和观察组（n=110）。对照组采用切开复位有限接触加压钢板治疗，观察组采用微创经皮钢板内固定（MIPPO）治疗，记录两组围术期指标，采用Harris评分对两组治疗后肢体功能进行评估，比较两组围术期指标、肢体功能及并发症发生率情况。 结果 观察组患者的手术、住院时间及术后骨折愈合时间明显比对照组短（P<0.05）；观察组患者在手术期间的出血量明显比对照组少（P<0.05）；两组患者在手术前Harris评分无明显差异（P>0.05）；术后6个月、12个月、18个月三次对观察组患者Harris评分比对照组明显增高（P<0.05）。术后18个月观察组患者出现并发症的比率为1.82%，而对照组患者出现并发症的比率为8.18%，两组间存在明显差异（P<0.05）。结论 使用微创经皮钢板内固定治疗老年患者的四肢骨折，能明显提高患肢功能，临床效果好，值得广泛应用。

[关键词] 微创手术；四肢骨折；肢体功能

[中图分类号] R683.4 [文献标识码] B [文章编号] 1673-9701（2018）10-0080-04

Clinical effect of minimally invasive surgery in the treatment of senile limb fractures and its impact on limb function

CHEN Lei

Department of Orthopedics，the First Affiliated Hospital of the Medical College， Shihezi University， Shihezi 832000，China

[Abstract] Objective To investigate the clinical effect of minimally invasive surgery on the treatment of limb fractures in the elderly and its effect on the function of limbs. Methods Totally 220 elderly patients with limb fractures in our hospital from December 2012 to December 2015 were selected as study subjects and were randomly divided into control group（n=110）and observation group（n=110）. The control group was treated with open reduction and limited contact and compression plate. The observation group was treated with minimally invasive percutaneous plate osteosynthesis（MIPPO）. The perioperative parameters of two groups were recorded. Harris score was used to evaluate the limb function after treatment. Perioperative parameters， limb function and the incidence of complications were compared between the two groups. Results The operation time， hospital stay and fracture healing time in the observation group was significantly shorter than that in the control group（P<0.05）. The intraoperative bleeding volume in the observation group was significantly less than that in the control group（P<0.05）. There was no significant difference in the Harris scores between the two groups before surgery（P>0.05）. Harris scores of patients in the observation group at 6 months， 12 months， 18 months after surgery were significantly higher than those in the control group（P<0.05）. The incidence of complications in the observation group was 1.82% at 18 months after surgery， while the incidence of complications in the control group was 8.18%. There was a significant difference between the two groups（P<0.05）. Conclusion Minimally invasive percutaneous plate osteosynthesis for the treatment of limb fractures in elderly patients can significantly improve limb function and has good clinical effect， which is worthy of widely application.

[Key words] Minimally invasive surgery；Limb fractures；Limb function

四肢骨折是一类骨折的统称，其中常见的老年四肢骨折主要为四肢长干骨骨折等，其诱因也相对较多，如交通事故、高处坠落以及重物撞击或挤压等高能量损伤，伴随我国经济的发展和人们生活方式的改变，使得老年四肢骨折发生率呈现上升趋势[1]。老年患者骨折后如果得不到及时有效的治疗，长期卧床后，骨骼畸形、疼痛等发生的概率会大幅度增加，对患者的健康及生活质产生极大影响。常规的手术方法是传统切开后直视下复位，然后使用加压钢板（目前多为有限接触加压钢板）固定，该方法基本能满足骨折治疗的基本要求，为传统方法，但是局部损伤较大，再加上患者骨折后伴有软组织的损伤，导致患者治疗预后较差[2]。……