三角肌外侧小切口切开复位锁定钢板内固定治疗肱骨近端骨折

Mini-open reduction through lateral deltoid muscle and locking plate fixation for proximal humeral fractures

目的探讨三角肌外侧小切口切开复位锁定钢板内固定治疗肱骨近端骨折的可行性及临床疗效。方法采用回顾性病例系列研究分析2012年9月-2015年9月收治的39例肱骨近端骨折患者的临床资料，其中男7例，女32例；年龄33～86岁，平均66．8岁。根据Neer分型：二部分骨折26例，三部分骨折13例，均采用三角肌外侧小切口切开复位锁定钢板内固定治疗。记录术前、术后疼痛视觉模拟评分（VAS）和肩关节Constant—Murley功能评分，观察肩关节活动度及并发症发生情况。结果患者均获随访12～48个月，平均21．3个月。患者均达到骨性愈合，骨性愈合时间（12．0±2．7）周。VAS从术前（5．7±1．0）分改善至末次随访（0．9±0．6）分（P〈0．05）。肩关节Constant—Murley功能评分从术前（42．3±5．1）分提高至末次随访（89．2±2．5）分（P〈0．05），其中优35例，良4例，优良率为100％。肩关节活动范围明显好转。无腋神经损伤、复位丢失、骨不连、肱骨头坏死等并发症。结论三角肌外侧小切口复位锁定钢板内固定治疗肱骨近端骨折具有微创、骨折愈合率高、肩关节功能恢复满意、并发症少等优点。

Objective To discuss the feasibility and clinical outcomes of mini-open reduction through lateral deltoid muscle and locking plate fixation in treatment of proximal humeral fractures. Methods A retrospective study was carried out on 39 patients with proximal humeral fractures treated with mini-open reduction through lateral dehoid muscle and locking plale fixation from September 2012 to September 2015. There were 7 males and 32 females, with a mean age of 66. 8 years （ range, 33- 86 years）. According to the Neer＇s classification system, there were 26 patients with two-part fracture and 13 with three-part fracture, visual analogue scale （VAS）, Constant-Murley shoulder score, time of bone healing and complications were evaluated for all patients. Results All patients were followed up for 12-48 months （mean, 21.3 months）. All fractures were proved to be bone healing with duration of （ 12.0 ± 2.7 ） weeks. The VAS was improved from preoperative （5.7 ± 1.0 ） points to （ 0.9 ± 0.6 ） points at the final follow-up （ P 〈 0. 05 ）. The Constant-Murley shoulder score was increased from preoperative （42.3 ± 5. 1 ） points to （ 89, 2 ± 2.5 ） points at the final follow-up （ P 〈 0. 05 ）. Ranges of shoulder motion were improved with satisfactions. There were no complications like axillary nerve injury, loss of reduction, nonunion or humeral head necrosis. Conclusion For proximal humeral fractures, the miniopen reduction through lateral deltoid muscle and locking plate fixation has advantages of minimal invasion, excellent shoulder function, high rate of bone healing and low incidence of complications.