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目的 探究经皮微创接骨板内固定术(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗肱骨近端Neer Ⅲ、Ⅳ部分骨折的临床优势. 方法 回顾性分析自2015年5月至2018年5月我院分别采用MIPPO与ORIF手术治疗肱骨近端Neer Ⅲ、Ⅳ部分骨折患者78例.MIPPO组36例,男20例,女16例,其中Ⅲ部分骨折21例,Ⅳ部分骨折15例;ORIF组42例,男24例,女18例,其中Ⅲ部分骨折26例,Ⅳ部分骨折16例.比较术中切口长度、出血量、手术时间、骨折愈合时间,术前及术后3、6个月肩关节UCLA评分,术后3、6、12个月肩关节功能Constant-Murley评分,末次随访关节功能分级及腋神经损伤等并发症情况,骨折愈合后对MIPPO组进行肩关节功能评估.结果 78例患者均获得随访,时间(17.3±2.8)个月.MIPPO组手术切口长度、骨折愈合时间、术中出血量均明显少于ORIF组.MIPPO组术后3、6个月肩关节UCLA评分29.04±1.63和30.95±1.69均高于ORIF组22.11±2.33和25.96±2.01.MIPPO组术后3、6个月肩关节功能Constant-Murley评分55.64±2.83和75.01±5.71均高于ORIF组45.03±6.32和64.61±6.77.但两组术后12个月肩关节功能Constant-Murley评分及末次肩关节功能分级差异均无统计学意义.骨折愈合后进一步评估MIPPO组肩关节功能:屈曲角度平均为170.5°(161°～ 180°),外旋角度平均为71°(63.5° ～ 83.5°),内旋角度平均为73.6° (68°～ 79°),活动度恢复均良好.MIPPO组的并发症发生率为5.56％,优于ORIF组的11.90％(P＜0.05).结论 MIPPO与ORIF均能治疗肱骨近端Ⅲ部分和Ⅳ部分骨折,前者相比于后者在术中切口长度、出血量、骨折愈合时间、3和6个月肩关节功能恢复、并发症等方面具有优越性,值得临床推广.“,”Objective To explore the clinical advantages of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of proximal humerus fractures of Neer type Ⅲ and Ⅳ.Methods From May 2015 to May 2018,78 cases of proximal humerus fractures of Neer type Ⅲ and Ⅳ were treated with MIPPO and open reduction and internal fixation (ORIF).There were 36 cases in MIPPO group,20 males and 16 females,including 21 cases of Part Ⅲ fractures and 15 cases of Part Ⅳ fractures;and 42 cases in ORIF group,24 males and 18 females,including 26 cases of Part Ⅲ fractures and 16 cases of Part Ⅳ fractures.The length of incision,the amount of bleeding,the time of operation,the time of fracture healing,the UCLA score of shoulder joint before and 3,6 months after operation,the Constant-Murley score of shoulder joint function at 3,6,12 months after operation,the classification of joint function at the last follow-up,the axillary nerve injury and other complications were compared.The shoulder joint function of MIPPO group was evaluated after fracture healing.Results All the 78 patients were follow-up for (17.3±2.8) months.The incision length,fracture healing time and intraoperative bleeding in MIPPO group were significantly shorter than those in ORIF group.The UCLA scores of shoulder joint in MIPPO group were 29.04±1.63 and 30.95±1.69 at 3 and 6 months after operation,which were higher than those in ORIF group 22.11±2.33 and 25.96±2.01.The shoulder function Constant-Murley scores of MIPPO group were 55.64±2.83 and 75.01±5.71 at 3 and 6 months after operation,which were higher than those of ORIF group 45.03±6.32 and 64.61±6.77.However,there was no significant difference between the two groups in the shoulder function Constant-Murley score and the last shoulder function grade at 12 months after operation.After fracture healing,the shoulder function of MIPPO group was further evaluated:the average flexion angle was 170.5 ° (ranged,161° to 180°),the average external rotation angle was 71° (ranged,63.5° to 83.5°),the average internal rotation angle was 73.6 ° (ranged,68° to 79°) and the recovery of mobility was good.The complication rate of MIPPO group was 5.56％,which was better than that of ORIF group 11.90％ (P＜0.05).Conclusion Both MIPPO and ORIF can treat proximal humerus fractures of Neer type Ⅲ and Ⅳ.The former is superior to the latter in incision length,bleeding volume,fracture healing time,shoulder joint function recovery at 3 and 6 months after operation,complications and other aspects,which is worth clinical promotion.