劈三角肌的肩峰下前外侧扩展入路治疗肱骨近端骨折

Surgical treatment of proximal humeral fractures through extended anterolateral acromial approach of deltoid-splitting

目的：探讨劈三角肌的肩峰下前外侧扩展入路治疗肱骨近端骨折的方法及疗效。方法2010年10月至2014年2月，采用劈三角肌的肩峰下前外侧扩展入路治疗肱骨近端骨折35例，根据Neer分型：2部分骨折12例，3部分骨折21例，4部分骨折2例。术中将三角肌于前、中亚部纵行劈开并显露保护腋神经，骨折复位后锁定钢板固定。结果30例患者获得随访，随访时间8～24个月，骨折均达骨性愈合，未发生腋神经损伤。肩关节功能评价采用Neer评分系统：优16例，良8例，可3例，差3例；优良率80%。结论劈三角肌的肩峰下前外侧扩展入路能够有效地显露和保护腋神经，直视下进行骨折复位及钢板固定，具有创伤小，出血少，操作方便的优点。

Objective To investigate the methods and clinical outcomes of the proximal humeral fracture treatment through extended anterolateral approach of deltoid-splitting approach. Methods From October 2010 to February 2014, 35 patients with proximal humeral fractures were treated through deltoid-splitting approach. According to the Neer classification：there were 12 cases of two-part fracture, 21 three-part fracture and 4 four-part fracture. The deltoid muscle was split from the gap of the front and middle and the axillary nerve was revealed and protected, thenthe fracture was fixed with anatomic locking plate after reduction. Result Thirty of 35 patients were followed up from 8 to 24 months. All fractures healed up. Axillary nerve injury was not found. According to Neer criteria for shoulder joint function： excellent in 16 cases, good in 8, fair in 3 cases, bad in 3 cases. The excellent and good rate was 80%. Conclusion The extended anterolateral acromial approach of deltoid-splitting can reveal and protect the axillary nerve effectively, and open reduction and plate fixation can be performed under direct vision. It has the advantage of the little trauma, less bleeding and convenient operation.