肩峰下劈三角肌扩展入路钢板内固定治疗肱骨近端骨折

Extended deltoid-splitting approach for plate fixation of the proximal humeral fractures

目的探讨采用肩峰下劈三角肌扩展人路钢板内固定治疗肱骨近端骨折的临床疗效。方法回顾性分析自2007年8月-2011年5月应用肩峰下劈三角肌扩展入路钢板内固定治疗肱骨近端骨折12例。记录手术时间、术中出血量、术后并发症情况、观察术后骨折复位情况、不同时间肩关节活动度、采用Constant—Murley肩关节功能评分对肩关节功能进行评价。结果12例获得随访4—16个月，平均10个月。平均手术时间为（74．58±9．88）min；术中平均出血量为（105±26．11）ml；术后均无腋神经损伤症状发生。骨折复位均满意，所有骨折均获得愈合，愈合时间12—18周，平均14周。术后3个月时Constant—Murley肩关节功能评分平均（80．08±6．42）分。结论采用肩峰下劈三角肌扩展入路钢板内固定治疗肱骨近端骨折有着操作简单、损伤小、组织剥离少、暴露清楚、方便钢板放置和固定操作、对肱骨头血运影响小、术后肩关节功能恢复快的优点。

Objective To evaluate the clinical outcome of plate fixation of the proximal humeral fractures by using the extended deltoid-splitting approach. Methods From August 2007 to May 2011, twelve patients with displaced fractures of the proximal humerus were treated with the extended deltoid-splitting approach and a locking plate fixation. Reduction and healing time of the fracture, operating time, blood loss, and mobility of should were observed after surgery. The shoulder function was evaluated by Constant-Murley score. Results All patients were followed-up, the mean time was 10 months （range 4-16 months）. The mean operating time was （74.58±9.88）rain, the mean blood losses were （105±26.11 ）mL Fractures were healed with an average of 12 weeks （range 14±18 weeks）. There were no axillary nerve deficits postoperatively related to the approach, and the average Constant-Murley score was （80.0±6.42）. Conclusion The extended deltoid splitting approach allows direct access to the lateral fracture planes for fracture reduction and plate placement without placing the adjacent neurovascular structures at risk of injury, and offers a useful alternative to the dehopectoral approach in the surgical treatment of proximal humeral fractures.