经扩大的三角肌入路手术治疗肱骨近端骨折

Surgical treatment of proximal humeral fractures through enlarged tricepts-split approach

目的探讨经扩大的三角肌入路手术治疗肱骨近端骨折的方法及临床疗效。方法自2008年1月～2010年10月采用经扩大的三角肌入路手术治疗肱骨近端骨折27例，其中22例资料完整。自肩峰向下，于肩关节外侧正中作8～10cm的纵形切口（自肩峰至三角肌附丽点），钝性劈开三角肌至三角肌肱骨止点，在肩峰下5cm处显露并保护腋神经，显露肱骨近端。骨折复位后采用解剖型接骨板固定。结果本组平均随访18个月（8～34个月），均达到或接近解剖复位，骨折均愈合，平均愈合时间16．1周。疗效评定按Neer评分：优10例，良7例，可3例，差2例，优良率77．27％。无腋神经损伤的患者。结论经三角肌正中纵切口显露肱骨近端，游离并保护腋神经，降低了手术操作难度，术后恢复良好，随访效果满意，是一种可以采用的手术入路。

Objective To investigate the methods and clinical outcomes of the proximal humeral fracture treated surgically through the enlarged transdehoid approach. Methods All of 27 patients with proximal humeral fractures were treated surgically through enlarged tansdeltoid approach between January 2008 and October 2010, while 22 fractures had integral materials. The longitudinal incision （range, 8-10cm） went on midhumeral line besides the shoulder joint （from the acromion to attachment of deltoid）. Deltoid and its attachment were split bluntly, then axillary nerve was protected 5era below the aeromion, in order to expose the proximal humerus. Anatomy plate was used to fix the fracture after reduction. Results During an average of 18 months follow up （ range 8-34 months）, all got anatomical reduction and healed in 16.1 weeks on average. According to Neer Score, 10 fracture were excellent, 7 good, 3 fair, 2 bad. The excellent and good rate was 77.27 percent. There was no injured axillary nerve. Conclusion The proximal humerus can be exposed through the transdeltoid approach, the axiUary nerve is then freed and protected. The approach makes the operation simple, The fractures get satisfactory outcomes during follow up after surgery. The transdeltoid approach is recommendable.