两种不同入路在锁定钢板治疗肱骨近端骨折中的疗效分析

Clinical Effects of Two Different Approach for Treating Proximal Humeral Fractures with Locking Plate

目的：探讨应用锁定钢板经肩峰前外侧和胸三角肌两种不同手术入路在治疗肱骨近端骨折中的临床治疗效果。方法：选取2012年2月-2014年4月本院收治的肱骨近端骨折患者59例作为研究对象,将其随机分为经肩峰前外侧入路组27例和经胸三角肌入路组32例,两组均运用锁定钢板对肱骨近端行切开复位内固定手术。比较两组术中、术后的多项相关指标及术后12～15个月的肩关节功能Neer评分情况。结果：59例均获得随访,平均随访14.8个月;经肩峰前外侧入路组相对于经胸三角肌入路组在切口长度、术中失血量、手术时间、术后引流量、骨折愈合时间的差异均有统计学意义（P〈0.05）;术后两组均未发生明显并发症;术后12～15个月的肩关节功能Neer评分,经肩峰前外侧入路组优良率为84.6%,经胸三角肌入路组优良率为82.4%,两组优良率比较差异无统计学意义（P〉0.05）。结论：应用锁定钢板经肩峰前外侧和胸三角肌两种不同手术入路均是治疗肱骨近端骨折的有效方式。与传统的经胸三角肌入路相比,经肩峰前外侧入路具有创伤小、术中出血少、手术时间短、骨折愈合快、肩关节功能恢复快等优点,可作为治疗肱骨近端骨折的首选方法。

Objective： To investigate the clinical effects of two different approach through anterolateral acromial approach and dehopectoral approach for the treatment of proximal humeral fractures with locking plate.Method： Totally 59 patients with proximal humeral fractures were selected in our hospital from February 2012 to April 2014, they were divided into the through anterolateral acromial approach of 27 cases and through dehopectoral approach of 32 cases.All patients were treated by open reduction and internal fixation with locking plate.The indexes of intraoperative, postoperative situation and clinical effect （ Neer score ） at 12-15 months postoperatively were observed and compared.Result： All cases were followed up, averaging 14.8 months.The incision length, intraoperative bloodloss, operation time, postoperative drainage, fracture healing time of the through anterolateral acromial approach group showed statistically differences compared with the through dehopectoral approach group （P〈0.05） .Two groups were not apparent complications after surgery, the rate of excellent and good at 12-15 months postoperatively was 84.6% respectively in the through anterolateral acromial approach, while 82.4% respectively in the through dehopectoral approach group.The differences had no statistically significant （P〉0.05） .Conclusion： Both of anterolateral acromial approach and dehopectoral approach are effective in treating proximal humeral fractures with locking plate, and can obtain excellent outcomes.Moreover, anterolateral acromial approach has advantage of less trauma, less blood loss, shorter operative time, rapid recovery of fracture healing and shoulder joint function.This approach is the first choice for proximal humerus fracture.