经三角肌入路与三角肌胸大肌间隙入路治疗老年肱骨近端骨折的疗效比较

Comparison of therapeutic effects between transdeltoid approach and deltoid-pectoralis major space approach in treatment of proximal humerus fractures in elderly patients

目的比较经三角肌入路与三角肌胸大肌间隙入路治疗老年肱骨近端骨折的疗效。方法招募2021年2月至2023年1月于青海省第五人民医院行骨折切开复位内固定手术治疗的老年肱骨近端骨折患者50例。以采用三角肌胸大肌间隙入路手术者25例为对照组,采用三角肌入路手术者25例为观察组。比较两组手术时间、术中出血量、住院时间、骨折愈合时间、切口愈合时间、术后并发症,以及术后肩关节Constant-Murley评分、视觉模拟量表(VAS)评分。结果观察组手术时间、切口愈合时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。两组骨折愈合时间和住院时间比较差异无统计学意义(P>0.05)。观察组在术后即刻、术后7 d的VAS评分低于对照组,肩关节Constant-Murley评分高于对照组,差异有统计学意义(P<0.05)。两组在术后3个月的肩关节VAS评分、Constant-Murley评分比较差异无统计学意义(P>0.05)。两组并发症发生率比较差异无统计学意义(12.00%vs 16.00%;χ^(2)=0.000,P=1.000)。结论经三角肌入路治疗肱骨近端骨折可减少术中出血,减轻伤口疼痛,缩短切口愈合时间,利于术后早期实施功能锻炼,改善肩关节功能。

Objective To compare the therapeutic effects between transdeltoid approach and deltoid-pectoralis major space approach in treatment of proximal humerus fractures in elderly patients.Methods Fifty elderly patients with proximal humerus fractures who underwent open reduction and internal fixation surgery in the Fifth People′s Hospital of Qinghai Province from February 2021 to January 2023 were recruited.The control group included 25 patients who underwent deltoid-pectoralis major space approach.The observation group included 25 patients who underwent transdeltoid approach.The operation time,intraoperative blood loss,duration of hospital stay,fracture healing time,incision healing time,postoperative complications,postoperative Constant-Murley scores and Visual Analogue Scale(VAS)scores of shoulder joints were compared between the two groups.Results The operation time and the incision healing time in the observation group were shorter than those in the control group,and the intraoperative blood loss in the observation group was less than that in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the fracture healing time and the duration of hospital stay between the two groups(P>0.05).The VAS scores in the observation group were lower than those in the control group immediately after operation and 7 days after operation,and the Constant-Murley scores of the shoulder joints in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the VAS scores and Constant-Murley scores of the shoulder joints 3 months after operation between the two groups(P>0.05).There was no significant difference in the incidence of complications between the two groups(12.00%vs 16.00%;χ^(2)=0.000,P=1.000).Conclusion The treatment of proximal humerus fracture by transdeltoid approach can reduce intraoperative blood loss,relieve wound pain,shorten incision healing time,facilitate the early implementation of functional exercise after operation,and improve shoulder joint function.