肩外侧三角肌入路治疗肱骨近端Neer三、四部分骨折

Lateral deltoid approach in the treatment of Neer three and four part proximal humerus fractures

目的：探讨肩关节外侧三角肌入路治疗肱骨近端Neer三、四部分骨折的疗效。方法采用肩外侧三角肌外侧入路手术治疗31例肱骨近端Neer三、四部分骨折患者。结果患者均获得随访，时间11-29个月。骨折临床愈合时间11-21周。末次随访肩关节活动度：前屈131．6°±3．9°，后伸42．5°±2．6°，外展89．2°±2．6°，内收36．6°±2．8°。末次随访肩关节Constant评分76．7分±12．3分；未发生三角肌萎缩、肱骨头坏死情况。结论肩关节外侧三角肌入路是手术治疗肱骨近端严重骨折的良好入路，可取得理想的疗效。

Objective To investigate the efficacy of lateral deltoid approach in locking plate fixation of Neer three and four part proximal humerus fractures. Methods Thirty-one cases with Neer three or four part fracture of the proximal humerus were treated by open reduction and locking plate internal fixation via the lateral deltoid approach. Results All the patients were followed up from 11 months to 29 months. The fracture healing time was from 11 weeks to 21 weeks. The shoulder joint activity degrees were：flexion 131. 6° ± 3. 9°, extension 42. 5° ± 2. 6°, abduction 89. 2° ± 2. 6°, adduction 36. 6° ± 2. 8° at the end of follow-up. The Constant score was （76. 7 ± 12. 3） points at last follow-up. No deltoid muscle atrophy and humeral head necrosis had occurred. Conclusions Lateral deltoid approach is a good approach for surgical treatment of severe proximal humeral fracture, the ideal therapeutic effect can be achieved.