三角肌劈开入路微创治疗肱骨近端骨折的临床研究

Minimally invasive deltoid-splitting approach for treatment of proximal humeral fractures： a case-control study

目的 评价三角肌外侧劈开入路经皮微创锁定钢板内固定治疗肱骨近端骨折的临床疗效.方法 2010年6月至2012年12月,采用锁定钢板内固定治疗肱骨近端骨折60例,其中27例采取经三角肌外侧劈开入路,经皮微创锁定钢板内固定治疗（DS组）,33例采取胸大肌-三角肌入路锁定钢板内固定治疗（DP组）.比较两组之间手术时间、术中出血量、伤口并发症及住院时间.术后应用Constant评分系统对肩关节功能进行评定.结果 术后全部患者获得12～ 24个月随访,平均18.6个月.DS组和DP组两组手术时间比较差异无统计学意义（P＞0.05）,DS组平均出血量较少（P＜0.05）,平均住院日DS组较DP组缩短5 d（P＜ 0.05）,两组骨折愈合时间比较差异无统计学意义（P＞0.05）,并发症发生率DS组低于DP组（P＜0.05）.肩关节功能Constant评分DS组在术后3个月随访时显著高于DP组,术后6个月及12个月时两组比较差异无统计学意义（P＞0.05）.结论 三角肌外侧劈开入路经皮微创锁定钢板内固定治疗肱骨近端骨折具有术中出血少、术后功能恢复快及并发症发生率低等优点,是治疗肱骨近端骨折有效的方法.

Objective To evaluate the clinical outcomes of minimally invasive percutaneous locking plate osteosynthesis （MIPPO） via deltoid-splitting approach in the treatment of proximal humeral fractures.Methods From June 2010 to December 2012,60 cases of proximal humeral fractures were treated in our hospital with locking plate osteosynthesis.Among them,27 cases were treated with minimally invasive percutaneous plate osteosynthesis （MIPPO） via the anterolateral dehoid-splitting approach （group DS）,while 33 cases were treated with open reduction and internal fixation through a traditional deltopectoral approach （group DP）.Operation time,blood loss,wound complications and hospital stay time were compared between these two groups.Postoperative shoulder functions were assessed using Constant scores.Results Patients were follow-up for 12 to 24 months （average,18.6 months）.There was no difference in the operation time between the two groups （P ＞ 0.05）.Blood loss was lower in the DS group than in the DP group （P ＜ 0.05）.The DS group had a significantly shorter hospital stay than the DP group （P ＜ 0.05）.The difference of the mean healing time between two groups was not significant.The mean Constant score after 3 months showed higher values for group DS versus group DP.However at 6 and 12 months follow-up the scores of two groups had no statistically significant difference.The rate of complications of the DS group was lower than that of the DP group （P ＜ 0.05）.Conclusion Pereutaneous locking plate osteosynthesis via deltoid-splitting approach has the advantages of less blood loss,less vascular damage,lower risk of complications and rapid recovery.It is an effective treatment for proximal humeral fractures.