三角肌外侧直切口治疗肱骨近端骨折的临床疗效研究

A clinical study on the treatment of proximal humeral fractures with lateral straight deltoid incision

目的比较三角肌外侧直切口与三角肌胸大肌肌间隙切口复位,肱骨近端解剖型锁定钢板固定治疗老年肱骨近端骨折的临床疗效。方法55例肱骨近端骨折患者,按照手术入路不同分为A组(30例)和B组(25例)。A组采用传统三角肌胸大肌肌间隙入路,B组采用肩关节前外侧三角肌直切口入路,均植入肱骨近端解剖型锁定钢板进行骨折固定,55例均获得12~18个月的随访,平均随访13.5个月。比较两组术中出血量、手术时间、复位情况、术后并发症及术后12个月肩关节Constant评分。结果B组术中出血量(210±23)ml少于A组的(250±36)ml,手术时间(96±9)min短于A组的(106±13)min,术后12个月肩关节Constant评分(80.0±2.3)分高于A组的(71.6±5.2)分,差异具有统计学意义(P<0.05)。两组术后并发症、复位情况比较,差异无统计学意义(P>0.05)。结论三角肌外侧直切口可达到与三角肌胸大肌肌间隙入路同样的复位效果,同时具有切口直观、创伤小、并发症少、功能优等特点。

Objective To compare the clinical efficacy of reduction through lateral straight deltoid incision,the deltoid pectoralis major interspace incision and proximal humerus anatomical locking plate fixation in the treatment of proximal humerus fractures in the elderly.Methods A total of 55 patients with proximal humerus fractures were divided into group A(30 cases)and group B(25 cases)by different surgical approaches.Group A received traditional deltoid and pectoralis major interspace approach,and group B received lateral straight deltoid incision approach.All 55 cases were followed up for 12-18 months,with an average follow-up of 13.5 months.The amount of intraoperative hemorrhage,surgery time,reduction status,occurrence of postoperative complications and Constant score of shoulder joint in postoperative 12 months were compared between the two groups.Results The amount of intraoperative hemorrhage(210±23)ml of group B was less than that of group A(250±36)ml,surgery time(96±9)min was shorter than that of group A(106±13)min,and Constant score of shoulder joint in postoperative 12 months(80.0±2.3)points was higher than that of group A(71.6±5.2)points,and the difference was statistically significant(P<0.05).There was no statistically significant difference in occurrence of postoperative complications and reduction status between the two groups(P>0.05).Conclusion Lateral straight deltoid incision can achieve the same reduction effect as the deltoid and pectoralis major interspace incision,and has the characteristics of intuitive incision,less trauma,fewer complications and superior function.