胸大肌三角肌入路和肩关节前外侧劈开三角肌入路治疗肱骨近端骨折的疗效比较

Deltopectoral approach versus anterolateral deltoid-split approach for proximal humeral fractures

目的 比较胸大肌三角肌入路与肩关节前外侧劈开三角肌入路钢板内固定治疗肱骨近端骨折的疗效, 方法 回顾性分析2010年1月至2011年5月收治的45例新鲜肱骨近端骨折患者资料,男17例,女28例;年龄52 ～ 85岁,平均62岁,根据手术入路不同分为常规组（采取胸大肌三角肌入路,20例）和微创组（采取肩关节前外侧劈开三角肌入路,25例）,均置入锁定钢板固定,分析比较术中出血量、手术时间、术中与术后并发症及术后3周、术后3个月和末次随访时Constant评分,随访复查患肩的正位X线片, 结果 所有患者术后随访时间为7 ～ 26个月（平均17个月）,无失访、死亡病例,无切口感染,所有患者均获骨性愈合,愈合时间为77～91 d,平均83 d.微创组术中出血量、手术时间、切口长度及愈合时间均明显优于常规组,差异有统计学意义（P＜0.05）,术后3周及术后3个月微创组患者Constant评分[（57.8±6.5）、（84.0±6.8）分]均优于常规组[（42.6±6.4）、（78.2±7.1）分],差异均有统计学意义（P＜0.05）,但末次随访时微创组患者Constant评分[（85.4±6.1）分]与常规组[（84.7±6.6）分]比较差异无统计学意义（P＞ 0.05）,常规组术中2例患者出现头静脉损伤患者, 结论 肩关节前外侧劈开三角肌入路较传统的胸大肌三角肌入路治疗肱骨近端骨折具有损伤更小、恢复更快的特点,且短期疗效较佳.

Objective To compared the deltopectoral approach versus anterolateral deltoid-split approach in the plate fixation of proximal humeral fractures.Methods A retrospective analysis was done of the 45 patients with fresh fracture of proximal humerus who had been treated in our department from January 2010 to May 2011.They were 17 males and 28 females,from 52 to 85 years of age （average,62 years）.According to the surgical approach they were divided into 2 groups：conventional group （the deltopectoral approach） of 20 patients and minimally invasive group （the anterolateral deltoid-split approach） of 25 cases.They all received locking plate fixation.The intraoperative blood loss,operation time,intraoperative and postoperative complications,Constant scores at 3 weeks,3 months and the last follow-up,as well as X-ray films of the affected shoulder at follow-up,were analyzed and compared between the 2 groups.Results The patients received an average follow-up of 17 months （from 7 to 26 months）.No loss to follow-up,death,or wound infection was found in this cohort.Bony healing was achieved in all after an average time of 83 days （from 77 to 91 days）.The minimally invasive group were significantly better than the conventional group in blood loss,operation time incision length,and union time （P ＜ 0.05）.The Constant scores at 3 weeks and 3 months in the minimally invasive group （57.8 ± 6.5 and 84.0 ± 6.8） were significantly higher than in the conventional group （42.6 ± 6.4 and 78.2 ± 7.1） （P ＜ 0.05）.However,there was no significant difference between the 2 groups in the Constant score at the last follow-up （85.4 ±6.1 versus 84.7 ±6.6） （P ＞ 0.05）.In the conventional group,2 cases of cephalic vein injury occurred.Conclusion The anterolateral deltoid-split approach can result in less invasion,faster recovery and better short-term outcomes than the conventional deltopectoral approach in the treatment of proximal humeral fractures.