侧卧位肩峰下联合小切口治疗Neer二、三部分肱骨近端骨折临床疗效

The Clinical Effect of Lateral Decubitus Subacromial Combined with Small Incision for Treatment of Neer Ⅱ or Ⅲ Partial Proximal Humerus Fractures

目的:探讨侧卧位肩峰下联合小切口结合传统正骨手法复位与传统胸大肌三角肌间隙入路治疗Neer二、三部分肱骨近端骨折对患者的临床疗效。方法:选择自2019年1月—2020年12月期间72例肱骨近端骨折患者,按手术入路及体位的不同方式分为两组,沙滩椅位下三角肌胸大肌入路和侧卧位肩峰下联合小切口前外侧入路进行钢板内固定治疗,观察术前和术后1周、3月、6月的患肩ASEs、Constant-Murley 评分、活动范围和骨折愈合情况以评估患肩功能;对比两组患者术中出血量、手术时间、住院时间、术后血常规(HGB变化)及术后并发症的情况对两种手术入路进行综合性评价。结果:两组入路患者术后1周、3月和6月的ASEs和Constant-Murley 评分较术前均有显著性提高(P<0.001);相较于胸大肌三角肌入路,侧卧位肩峰下联合小切口入路的手术出血,住院时间均有显著性降低(P<0.001);术后血红蛋白的丢失量较对照组也有显著性差异(P<0.001);两组患者中,均未出现感染、骨折不愈合、腋神经损伤等严重不良事件。结论:侧卧位肩峰下联合小切口治疗Neer二、三部分肱骨近端骨折综合疗效更好,具有手术创伤小,术后恢复快,术后并发症少等优势。

Objective:To investigate the clinical efficacy of combined small subacromial incision in the lateral recumbent position combined with traditional orthopedic manipulative repositioning versus a traditional pectoralis major deltoid gap approach for the treatment of Neer Ⅱ and Ⅲ partial proximal humerus fractures in patients.Methods:72 patients with proximal humerus fractures were collected from Jan 2019 to Dec 2020 and divided into two groups according to the different surgical approachs:beach chair position inferior deltoid pectoralis major approach group and lateral recumbent subacromial joint small incision anterolateral approach group.The ASEs,Constant-Murley,range of motion and fracture healing of the affected shoulder were observed preoperatively and 1 week,3 months and 6 months after surgery to assess the function of the affected shoulder.Also,the intraoperative blood loss,operative time,hospital stay,postoperative blood count (HGB changes) and postoperative complications were compared between the two groups to make a comprehensive evaluation of the two surgical approaches.Results:the ASEs and Constant Murley scores of the two groups at 1 week,3 months and 6 months after operation were significantly higher than those before operation (P< 0.001);compared with the deltoid approach of pectoralis major,the length of hospital stay of the subacromial combined small incision approach in lateral position was significantly lower (P< 0.001);the loss of hemoglobin after operation was also significantly different from that in the control group (P< 0.001);there were no serious adverse events such as infection,fracture nonunion and axillary nerve injury in the two groups.Conclusion:the combined small incision under the acromion in the lateral position has better comprehensive effect in the treatment of Neer Ⅱ and Ⅲ parts of proximal humeral fractures,with the advantages of less surgical trauma,rapid postoperative recovery and less postoperative complications.