肩峰下入路与三角肌入路锁定钢板内固定治疗老年肱骨近端骨折的效果分析

Analysis of the effect of locking plate internal fixation through subacromial approach and deltoid approach in the treatment of proximal humeral fractures in the elderly

目的分析肩峰下入路与三角肌入路锁定钢板内固定治疗老年肱骨近端骨折的效果。方法选取2018年1月至2020年2月本院收治的76例老年肱骨近端骨折患者,随机分为三角肌组和肩峰下组,各38例。三角肌组采用三角肌入路锁定钢板内固定进行治疗,肩峰下组采用肩峰下入路锁定钢板内固定进行治疗。比较两组手术情况、凝血功能及并发症发生情况。结果肩峰下组手术时间、住院时间、骨折愈合时间均短于三角肌组,术中出血量低于三角肌组(P<0.05)。治疗后,两组PT、APTT均低于治疗前(P<0.05),三角肌组血清FIB水平高于肩峰下组(P<0.05)。肩峰下组总并发症发生率为5.26%,显著低于三角肌组的21.05%(P<0.05)。结论肩峰下入路锁定钢板内固定可有效改善老年肱骨近端骨折患者手术情况和凝血功能,减少术后并发症的发生。

Objective To analyze the effect of locking plate fixation through subacromial approach and deltoid approach in the treatment of elderly proximal humeral fractures. Methods From January 2018 to February 2020, 76 elderly patients with proximal humeral fractures admitted to our hospital were selected and they were randomly divided into deltoid group and subacromial group, with 38 cases in each group. The deltoid group was treated by locking plate fixation via deltoid approach, and the subacromial group was treated by locking plate fixation via subacromial approach.The operation, coagulation function and complications were compared between the two groups. Results The operation time, hospitalization time and fracture healing time in subacromial group were shorter than those in deltoid group, and the intraoperative blood loss was lower than that in deltoid group(P<0.05). After treatment, PT and APTT in both groups were lower than before treatment(P<0.05), and serum FIB level in deltoid group was higher than that in subacromial group(P<0.05). The total complication rate in subacromial group was 5.26%, which was significantly higher than 21.05% in deltoid group(P<0.05). Conclusion Locking plate internal fixation through subacromial approach can effectively improve the operation and coagulation function of elderly patients with proximal humeral fractures, and reduce the occurrence of postoperative complications.