不同手术入路治疗老年肱骨近端骨折

Different surgical approaches for treatment of proximal humerus fractures in aged patients

目的探讨采用锁定钢板经小切口入路与三角肌胸大肌间隙入路治疗老年肱骨近端骨折的疗效。方法对98例采用两种不同手术入路结合锁定钢板治疗的患者,小切口入路52例,三角肌入路46例。比较两组手术时间、出血量、住院时间、骨折愈合时间和末次随访时肩关节Constant评分。结果患者均获随访,时间7～19(12±3)个月,骨折均愈合。小切口入路组手术时间、术中出血量、住院时间明显少于三角肌入路组(P<0.05、P<0.01),两组患者术后骨折愈合时间、Constant评分及手术优良率差异均无统计学意义(P>0.05)。小切口入路组的患侧肩关节的前屈、后伸、内收和外展较三角肌入路组改善更为明显(P<0.01)。结论小切口入路治疗老年肱骨近端骨折,可减少软组织损伤及骨折断端残留血供的破坏,复位满意,是一种安全、微创、有效的治疗方法。

Objective To study the clinical results of locking plate fixation through a small incision approach and the deltopectoral approach for treatment of proximal humerus fractures in aged patients.Methods There were 98 cases with two different surgical approach fixation with locking plate.52 cases were treated with small incision approach(small incision group),and 46 cases with deltopectoral approach(deltopectoral group).The operative time,blood loss,hospital stay,fracture healing time and the last follow-up Constant shoulder score were compared in two groups.Results All patients were followed up for 7 to 19 months(mean 12±3 months).All fractures were healed.The operation time,blood loss,hospital stay in small incision group were significantly less than those in deltopectoral group(P<0.05 and <0.01).The difference of the postoperative fracture healing time,Constant score and the excellent and good rate in two group was not statistically significant(P>0.05).The shoulder joint function of anterior flexion,posterior extend,adduction and abduction in small incision group was improved more obviously than that in deltopectoral group(P<0.01).Conclusions Fixation of elderly fracture of proximal humerus by minimally invasive approach from lateral shoulder is a safe,reliable and minimally invasive procedure.It can reduce the soft tissue injury and destruction of residual blood supply.