三角肌与三角肌胸大肌入路治疗老年肱骨近端骨折比较研究

Comparative Analysis of Clinical Efficacy of Deltoid Approach and Deltopectoral Approach for the Treatment of Elderly Proximal Humeral Fractures

目的对比分析三角肌与三角肌胸大肌间隙入路治疗NeerⅡ、Ⅲ型老年骨质疏松性肱骨近端骨折的临床疗效。方法自2013年1月至2017年1月采用肱骨近端锁定接骨板治疗NeerⅡ、Ⅲ型老年骨质疏松性肱骨近端骨折患者81例,其中肩峰下前外侧经三角肌微创入路(微创组)42例,男12例,女30例;年龄61~81岁,平均(69.8±10.4)岁。传统三角肌胸大肌入路(传统组)39例,男17例,女22例;年龄59~82岁,平均(68.7±12.6)岁。两组患者分别通过观察手术前后肌酸激酶、骨折复位质量、骨折愈合时间、肩关节肌力和功能评估两种手术入路的临床疗效。结果81例患者中有72例获得随访,其中微创组38例,传统组34例;随访时间12~58个月,平均35个月。两组患者在复位质量、骨折愈合时间方面比较,差异无统计学意义(P>0.05);在肌肉损伤(肌酸激酶)、肩关节肌力和肩关节功能方面比较,经三角肌微创组明显优于传统经三角肌胸大肌组(P<0.05)。结论经三角肌微创入路治疗NeerⅡ、Ⅲ型老年骨质疏松性肱骨近端骨折较传统三角肌胸大肌入路,具有手术创伤小、术后康复快等优点,临床疗效满意,可以做为治疗NeerⅡ、Ⅲ型老年骨质疏松性肱骨近端骨折的首选治疗方法。

Objective To comapre the clinical outcomes of NeerⅡandⅢelderly osteoporotic proximal humerus fractures by deltoid approach and deltopectoral approach.Methods From January 2013 to January 2017,81 patients with NeerⅡandⅢelderly osteoporotic proximal humeral fractures were treated with proximal humerus locking plate.Among them,42 cases were treated with minimally invasive approach through deltoid under anterolateral acromion,including 12 males and 30 females with an average of(69.8±10.4)years old(61~81 y).39 cases were treated with traditional deltopectoral approach,17 males and 22 females with an average age of(68.7±12.6)years old(59~82 y).The clinical efficacy of two surgical approaches were evaluated by observing pre-and post-operative creatine kinase,fracture reduction quality,fracture healing time,shoulder muscle strength and function.Results Of the 81 patients,72 follow-up,including 38 minimal approach and 34 traditional approach The follow-up period was 12 to 58 months with an average of 35 months.There was no significant difference in the quality of the reduction and healing time between the two groups(P>0.05),In the muscle injury(creatine kinase),shoulder muscle strength and shoulder function,the deltoid group was significantly better than the traditional deltopectoral group(P<0.05).Conclusion Compared with the traditional deltopectoral approach,the treatment of NeerⅡandⅢelderly osteoporotic proximal humeral fractures through the deltoid approach has the advantages of less surgical trauma and quick postoperative recovery.The clinical effect is satisfactory and can be used as preferred treatment for NeerⅡandⅢelderly osteoporotic proximal humerus fractures.