经三角肌双间隙入路手术对肱骨近端骨折患者术中出血量及肩关节功能的影响

The influence of deltoid muscle double interstitial approach of operation on intraoperative bleeding volume and shoulder joint function in patients with proximal humeral fracture

目的探讨经三角肌双间隙入路手术对肱骨近端骨折患者术中出血量及肩关节功能的影响。方法回顾性分析2017年3月—2019年3月本院收治的肱骨近端骨折患者62例临床资料,根据手术方法的不同分为对照组(30例)和观察组(32例)。对照组行三角肌与胸大肌间隙入路手术,观察组行三角肌双间隙入路手术。对比两组患者手术时间、术中出血量、术中引流量、疼痛程度以及肩关节功能。结果观察组手术时间、术中出血量、术中引流量均低于对照组,差异有统计学意义(P<0.05);术后7d、2个月、4个月,观察组VAS评分低于对照组,差异有统计学意义(P<0.05);术后1个月、2个月,观察组肩关节功能评分高于对照组,差异有统计学意义(P<0.05);术后4个月,观察组与对照组肩关节功能评分对比,差异无统计学意义(P>0.05)。结论肱骨近端骨折患者采用经三角肌双间隙入路手术较经三角肌与胸大肌间隙入路手术效果更好,可减少手术治疗时间和术中出血量,减轻患者术后疼痛程度,恢复患者肩关节功能。

Objective To investigate the influence of deltoid muscle double interstitial approach of operation on intraoperative bleeding volume and shoulder joint function in patients with proximal humeral fracture.MethodsThe clinical data of 62 patients with proximal humeral fracture who admitted in the hospital from March 2017 to March 2019 were retrospectively analyzed.All selected cases were divided into control group(30 cases) and observation group(32 cases) according to the different surgical procedures.Control group underwent the operation through the deltoid and pectoralis major space approach,and observation group was treated with deltoid muscle double interstitial approach of operation.The operation time,intraoperative bleeding volume,intraoperative drainage volume,degree of pain,and should joint function were compared between two groups.Results The operation time,intraoperative bleeding volume,intraoperative drainage volume in observation group were lower than those in control group,and the difference was statistically significant(P<0.05);After operation for 7 d,2 months and 4 months,the scores of VAS in observation group were lower than those in control group,and the difference was statistically significant(P<0.05);After operation for 1 month and 2 months,the scores of shoulder joint function in observation group were higher than those in control group,and the difference was statistically significant(P<0.05);After surgery for 4 months,there was no statistical difference in the score of shoulder joint function between observation group and control group(P>0.05).Conclusion Compared with the operation through the deltoid and pectoralis major space approach,deltoid muscle double interstitial approach of operation is more effective in treatment of patients with proximal humeral fracture,it can decrease operation time and intraoperative bleeding volume,reduce postoperative pain of patients,and promote recovery of shoulder joint function.