jktoКафедра травматологии и ортопедииDepartment of Traumatology and Orthopaedics2226-2016ПРОФИЛЬ — 2С10.17238/2226-2016-2023-4-86-96jkto-72Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWСравнение минимально инвазивного остеосинтеза и открытой репозиции и фиксации переломов проксимального отдела плечевой костиComparison of minimally invasive osteosynthesis and open reduction and internal fixation of proximal humerus fractureshttps://orcid.org/0000-0003-4136-644XТутуровА. О.TuturovA. O.

Александр Олегович Тутуров, врач-травматолог-ортопед

отделение хирургии кисти и реконструктивной микрохирургии

115446; Коломенский проезд, д. 4; Москва

Alexander Olegovich Tuturov, doctor

Department of Hand surgery and Reconstructive microsurgery

115446; Kolomenskiy p, 4; Moscow

atneuro@yandex.ruПетросянА. С.PetrosyanA. S.

Армен Сергеевич Петросян, кандидат медицинских наук, заведующий отделением

ортопедическое отделение

119620;  ул. Волынская, 7; Москва

Armen Sergeevich Petrosyan, Chief of department

orthopedics department

119620; Volinskaya str., 7; Moscow

armenak.p@gmail.comhttps://orcid.org/0000-0003-4686-7892ПанинМ. А.PaninM. A.

Михаил Александрович Панин, кандидат медицинских наук, врач-травматолог-ортопед, доцент

ортопедическое отделение; кафедра травматологии и ортопедии

119620; ул. Волынская, 7; 117198; ул. Миклухо-Маклая, 6; Москва

Mikhail Aleksandrovich Panin, doctor, PhD, associate Professor

Orthopedic Department; Department of traumatology and orthopedics

119620; Volinskaya str., 7; 117198; Mikluho-Maklaya str., 6; Moscow

panin-mihail@yandex.ruhttps://orcid.org/0000-0002-6680-9334ЕгиазарянК. А.EgiazaryanK. A.

Карен Альбертович Егиазарян, доктор медицинских наук, профессор, заведующий кафедрой

кафедра травматологии, ортопедии и военно-полевой хирургии

117997; Москва

Karen Albertovich Egiazaryan, MD, PhD, professor, chief of chair

chair of traumatology, orthopedics and military surgery

117997; Moscow

egkar@mail.ruГБУЗ «ГКБ им. С.С. Юдина ДЗМ»РоссияClinical Hospital named after S.S. YudinRussian FederationГБУЗ «ГКБ № 17 ДЗМ»РоссияClinical Hospital № 17Russian FederationГБУЗ «ГКБ № 17 ДЗМ»; ФГБОУ ВПО Российский университет дружбы народовРоссияClinical Hospital № 17; Peoples' Friendship University of RussiaRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияPirogov Russian National Research Medical UniversityRussian Federation202313032026048696Copyright © Тутуров А.О., Петросян А.С., Панин М.А., Егиазарян К.А., 20262026Тутуров А.О., Петросян А.С., Панин М.А., Егиазарян К.А.Tuturov A.O., Petrosyan A.S., Panin M.A., Egiazaryan K.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jkto.moscow/jour/article/view/72

   Около 5-6 % от всех переломов приходится на повреждение проксимального отдела плечевой кости. Тактика лечения зависит от множества факторов, включая степень смещения перелома, уровень активности пациента, сопутствующие травмы и заболевания, возраст, тип перелома и качество костной ткани. Наиболее приемлемыми оперативными опциями являются открытая репозиция и внутренняя фиксация (open reduction and internal fixation – ORIF), миниинвазивный остеосинтез пластиной (minimal invasive plate osteosynthesis – MIPO).

   Цель исследования

   Цель исследования: сравнить результаты исследований минимально инвазивной и открытой техник остеосинтеза проксимального отдела плечевой кости.

   Материалы и методы

   Материалы и методы: был проведен поиск в PubMed, EMBASE, Кокрановской библиотеке, ScienceDirect, Web оf Science, чтобы найти все соответствующие исследования в период 2015-2023 гг. Кроме того, был проведен поиск в списках литературы соответствующих исследований. Лингвистических ограничений не было.

   Результаты

   Результаты: отобранные 24 статьи по дизайну являлись ретроспективными исследованиями, 9 статей посвящены только методике MIPO, 1 клинический случай – билатеральный ORIF. Всего в исследованиях 1698 пациентов проанализировано. Средний период наблюдения был 25.2 мес. Средний возраст пациентов был 61.3 ± 8 лет. Наиболее частые осложнения были аваскулятный некроз головки плечевой кости, субакромиальный импиджмент, перфорация винтом, инфицирование области послеоперационной раны, варус коллапс (потеря медиальной опоры), несращение, повреждение подмышечного нерва. По сравнению с ORIF, MIPO имеет преимущества по времени операции, репозиции большого бугорка, кровопотере, послеоперационному болевому синдрому, функции плеча в раннем послеоперационном периоде и косметическому результату. Вместе с тем, MIPO требует более длительного времени проведения рентгеновского исследования интраоперационно по сравнению с ORIF и по результатам некоторых работ, не показано при многофрагментарных сложных переломах. Не выявлено значимой разницы в частоте осложнений между этими методами.

   Заключение

   Заключение: до сих пор ORIF является стандартной методикой остеосинтеза при сложных многофрагментарных переломах. Однако, по многим показателям существенно не отличается от минимально инвазивной. Техника MIPO показывает себя перспективной и требует расширения показаний для применения.

   About 5-6 % of all fractures occur in damage to the proximal humerus. Treatment depends on many factors, including the degree of fracture displacement, the patient's activity level, associated injuries and diseases, age, fracture type, and bone quality. The most acceptable surgical options are open reduction and internal fixation (ORIF), minimal invasive plate osteosynthesis (MIPO).   Purpose of the study: to compare the results of studies of minimally invasive and open techniques of osteosynthesis of the proximal humerus.   Materials and methods: PubMed, EMBASE, Cochrane Library, ScienceDirect, WebOfScience were searched to find all relevant studies in the period 2015-2023. In addition, the literature lists of relevant studies were searched. There were no linguistic restrictions.   Results: Selected 24 studies by design were retrospective studies, 9 articles were devoted only to the MIPO technique, 1 clinical case was bilateral ORIF. A total of 1698 patients were analyzed in the studies. The mean follow-up period was 25.2 months. The mean age of the patients was 61.3 ± 8 years. The most common complications were avascular necrosis of the humeral head, subacromial impingement, screw perforation, infection of the postoperative wound area, varus collapse (loss of medial support), nonunion, and axillary nerve injury. Compared to ORIF, MIPO has advantages in terms of operative time, tuberculum major reposition, blood loss, postoperative pain, early postoperative shoulder function, and cosmetic outcome. MIPO requires a longer intraoperative x-ray time. MIPO requires a longer intraoperative x-ray time and is not indicated for multifragmentary fractures according to few articles. There was no significant difference in complication rates between these methods.   Conclusion: Until now, ORIF is the standard osteosynthesis technique for complex multifragmentary fractures. However, it does not differ significantly from the minimally invasive technique. The MIPO technique shows itself to be promising and requires an expansion of indications for use.

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The authors declare that there are no conflicts of interest present.