小切口与传统术式治疗肱骨外科颈骨折疗效比较

Comparison of the small incision surgery and the traditional surgery for humeral surgical neck fracture

目的对比小切口与传统开放术式应用锁定加压钢板在肱骨近端骨折治疗中的临床疗效。方法对肱骨外科颈骨折55例,随机分为肩外侧小切口微创入路25例(小切口组)和传统的肩关节前内侧切口入路30例(传统组),均使用锁定加压钢板固定术。记录并比较两组手术时间,术中出血量,切口长度,术后功能Neer评分,骨折愈合时间。结果小切口组和传统组平均手术时间分别为(81.32±12.25)min和(138.80±19.25)min,术中出血量分别为(162.40±21.07)ml和(344.00±77.35)ml,切口长度分别为(9.08±1.66)cm和(15.06±1.12)cm,Neer评分分别为92.84±4.29和85.20±6.73。两组手术时间、术中出血量、切口长度、Neer评分比较均有统计学差异(P<0.05)。小切口组和传统组骨折愈合时间分别为(8.88±1.90)min和(8.60±2.25)min,差异无统计学意义(P>0.05)。结论锁定加压钢板治疗肱骨外科颈骨折,与传统术式相比,肩外侧小切口入路具有创伤小、显露简单、术中失血量少、手术时间短、术后肩关节功能恢复佳等优点,但不能缩短骨折愈合时间。

Objective To compare the clinical efficacy of the small incision and the traditional open surgery with the locking compres- sion plate in the treatment of proximal humerus fractures. Methods Fifty-five cases of humeral surgical neck fractures were randomly divided into two groups：mini-incision approach from the lateral shoulder in 25 cases（ mini-incision group） ,and the traditional antero- medial incision approach in 30 cases（ traditional group）. All fractures were fixated with the locking compression plates. The operation time, the blood loss, the incision length, the postoperative Neer score, the healing time of bone were recorded. All the data were analyzed by SPSS17.0 statistical software. Results The mean operative time was （81.32 ± 12.25） min and （ 138.80 ± 19.25 ） min in mini- incision group and traditional group （ P 〈 0.05 ） , the blood loss was （ 162.40 ± 21.07 ） ml and （ 344.00 ± 77.35 ） ml （ P 〈 0.05 ） , the in- cision lengths were （ 9.08 ± 1.66 ）em and （ 15.06 ± 1.12） cm （ P 〈 0.05 ）, and the Neer scores were 92.84 ± 4.29 and 85.20 ± 6.73 in mini-incision group and traditional group （ P 〈 0.05 ）. The fracture healing time was （ 8.88 ± 1.90 ） min and （ 8.60 ± 2.25 ） min in mini-incision group and traditional group, but there was no statistical difference. Conclusion The mini-incision approach from lateral shoulder to fixate humeral surgical neck fracture with the locking compression plate has the advantages of smaller incision, shorter oper- ation time, less blood loss and better postoperative shoulder joint function recovery.