两种手术入路治疗老年肱骨近端骨折的疗效比较

Comparison of two surgical approaches for treatment of proximal humerus fractures in aged patients

[目的]比较肩峰下前外侧"T"型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]2005年1月～2009年6月间分别采用两种不同手术入路结合锁定钢板治疗老年肱骨近端骨折共65例。肩峰下前外侧"T"型切口入路组31例,年龄60～84岁(平均71岁),按Neer分类2部分骨折11例,3部分骨折15例,4部分骨折5例;三角肌胸大肌间隙入路组34例,年龄60～81岁(平均70岁),按Neer分类2部分骨折9例,3部分骨折18例,4部分骨折7例。比较两组手术时间、出血量、末次随访时肩关节Constant评分。[结果]所有患者均获随访,随访时间12～24个月(平均16个月),骨折均愈合。肩峰下前外侧"T"型切口入路组手术时间及出血量明显少于三角肌胸大肌间隙入路组(P<0.01),而两组患者术后患侧肩关节功能无统计学意义上的差异(P>0.05)。[结论]肩峰下前外侧"T"型切口入路结合锁定钢板治疗肱骨近端骨折具有功能恢复好、对局部及全身损伤小的特点,特别适合于老年患者的治疗,但必须熟悉局部解剖并且掌握合适的手术指征。

[Objective]To compare the clinical results in the anterolateral acrominal approach of ＂T＂ type and the deltopectoral approach for treatment of proximal humerus fractures in aged patients. [Method]From January 2005 to June 2009,65 aged patients with humerus fractures were treated with locking plates through two surgical approaches.Thirty-one patients were treated through the anterolateral acrominal approach of ＂T＂ type,with age of 60-84（mean,71）years.According to Neer classification,11 cases were two-part fractures,15 cases were three-part fractures,and 5 case were four-part fractures.Thirty-four patients were treated through the deltopectoral approach,with age of 60-81（mean,70）years.According to Neer classification,9 cases were two-part fractures,18 three-part fractures,and 7 four-part fractures.Operation time,bleeding volume and Constant shoulder score were recorded and compared. [Result]A follow-up of 12-24（mean,16）months for all cases showed that all fractures were healed.There were significant differences in operation time and bleeding volume between the two groups（P0.01）.And there was no significant difference in Constant shoulder score between the two groups（P0.05）. [Conclusion]Fixation of proximal humerus fractures with locking plates through the anterolateral acrominal approach of ＂T＂ type is safe and effective.It is especially suitable for treatment of fractures in aged patients.