经三角肌入路联合锁定接骨板内固定对肱骨近端骨折患者术后疼痛程度及肩功能的影响

Effect of deltoid approach combined with locking plate internal fixation on the degree of postoperative pain and shoulder function in patients with proximal humeral fracture

探究经三角肌入路联合锁定接骨板内固定对肱骨近端骨折患者术后疼痛程度及肩功能的影响。方法 选取本院2015年1月至2017年2月肱骨近端骨折患者137例，依据治疗方式不同分组，对照组68例予以经三角肌胸大肌间隙入路结合锁定接骨板内固定治疗，研究组69例予以经三角肌入路联合锁定接骨板内固定治疗，分析比较两组手术及术后恢复情况、疼痛程度（VAS）、肩关节功能（Neer）、生活质量（WHOQOL-100）评分、骨折愈合时间、并发症。结果 研究组切口长度[（7.13±0.78）cm比（12.41±2.81）cm]小于对照组，手术用时[（53.69±8.61）min]、术中失血量[（156.41±20.68）ml]、术后引流量[（86.53±9.81）ml]、住院用时[（6.84±1.16）d]少于对照组，差异有统计学意义（P＜0.05）；末次随访研究组VAS评分[（1.59±0.24）比（2.14±0.89）]低于对照组，Neer评分[（92.31±12.67）比（81.27±8.02）]、WHOQOL-100评分[（93.61±9.48）比（84.13±7.32）]高于对照组，差异有统计学意义（P＜0.05）；研究组骨折愈合时间短于对照组[（9.43±1.58）周比（11.21±2.43）周]，差异有统计学意义（t=5.090，P=0.000）；研究组并发症总发生率低于对照组[1.45%（1/69）比14.71%（10/68）]，差异有统计学意义（P＜0.05）。结论 肱骨近端骨折患者予以经三角肌入路联合锁定接骨板内固定治疗效果显著，可有效缩短骨折愈合时间，减轻疼痛，改善肩功能，提升生活质量。

To investigate the effect of deltoid approach combined with locking plate internal fixation on the degree of postoperative pain and shoulder function in patients with proximal humeral fracture.Methods A total of 137 cases of proximal humeral fractures in our hospital from January 2015 to February 2017 were selected and were divided into two groups according to different treatment methods.The control group(n=68)was treated with deltoid muscle pectoralis major approach combined with locking plate internal fixation,while the study group(n=69)was treated with deltoid approach combined with locking plate internal fixation.The status of the operation and postoperative recovery,pain degree(VAS),shoulder function(Neer),quality of life(WHOQOL-100)score,fracture healing time,and complications were analyzed and compared between the 2 groups.Results The incision length of the study group[(7.13±0.78)cm]was less than that of the control group,and the operation time[(53.69±8.61)min],intraoperative blood loss[(156.41±20.68)ml],postoperative drainage volume[(86.53±9.81)ml],hospitalization time[(6.84±1.16)d]were less than those of the control group(P<0.05).At the end of the follow-up,the VAS score of the study group was lower than that of the control group[(1.59±0.24)points vs.(2.14±0.89)points],and the scores of Neer,WHOQOL-100 were higher than those of the control group[(92.31±12.67)points vs.(81.27±8.02)points;(93.61±9.48)points vs.(81.27±8.02)points](P<0.05).The fracture healing time in the study group was shorter than that in the control group[(9.43±1.58)weeks vs.(11.21±2.43)weeks;t=5.090,P=0.000].The total complication rate in the study group was 1.45%(1/69),lower than that in the control group[14.71%(10/68)](P<0.05).Conclusion Deltoid approach combined with locking plate internal fixation is effective in the treatment of proximal humeral fractures,which can effectively shorten the healing time of fracture,reduce pain,improve shoulder function,and improve the quality of life.