肩峰下前外侧入路与胸大肌三角肌入路锁定钢板内固定治疗老年肱骨近端二、三部分骨折的对比研究  

A comparative study of locking plate internal fixation through subacromial anterolateral approach versus ectopectoralis-deltoid approach for treatment of Neer 2-part and 3-part proximal humeral fractures in the aged

作　　者：姚华海 孙龙泰 崔龙慷 王晓洛 吴连国 YAO Huahai SUN Longtai CUI Longkang WANG Xiaoluo WU Lianguo(Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China The Second Affiliated Hospital of Zhengjiang Chinese Medical University, Hangzhou 310005, Zhejiang, China)

机构地区：[1]浙江中医药大学,浙江杭州310053 [2]浙江中医药大学附属第二医院,浙江杭州310005

出　　处：《中医正骨》2017年第9期1-6,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：浙江省一流学科(B类)建设项目

摘　　要：目的:比较肩峰下前外侧入路与胸大肌三角肌入路锁定钢板内固定治疗老年肱骨近端二、三部分骨折的临床疗效和安全性。方法:回顾性分析72例老年肱骨近端二、三部分骨折患者的病例资料,其中采用肩峰下前外侧入路锁定钢板内固定37例,采用胸大肌三角肌入路锁定钢板内固定35例。男31例,女41例。年龄61~92岁,中位数73岁。肱骨近端骨折Neer二部分骨折33例,三部分骨折39例。受伤至手术时间1~7 d,中位数3 d。比较2组患者手术时间、术中出血量、住院时间、骨折愈合时间及并发症发生情况,并分别比较术后3个月、6个月及12个月时2组患者的Neer肩关节评分。结果:(1)一般指标。肩峰下前外侧入路组的手术时间、住院时间、骨折愈合时间均短于胸大肌三角肌入路组[(52.31±21.34)min,(87.52±22.71)min,t=2.874,P=0.023;(10.21±3.17)d,(14.21±2.91)d,t=1.952,P=0.037;(11.73±3.51)周,(14.18±2.90)周,t=2.357,P=0.047],术中出血量小于胸大肌三角肌入路组[(87.93±2.74)mL,(153.24±3.51)mL,t=-3.237,P=0.017]。(2)Neer肩关节评分。时间因素和分组因素存在交互效应(F=12.734,P=0.000);2组患者Neer肩关节评分总体比较,组间差异有统计学意义,即存在分组效应(t=2.714,P=0.032);术后不同时间点间Neer肩关节评分的差异有统计学意义,即存在时间效应(F=297.094,P=0.000);2组患者Neer肩关节评分随时间均呈增加趋势,但是2组的增加趋势不完全一致;术后3个月、术后6个月,肩峰下前外侧入路组Neer肩关节评分均高于胸大肌三角肌入路组[(74.53±16.35)分,(63.25±15.27)分,t=2.173,P=0.023;(87.74±5.35)分,(74.83±6.58)分,t=3.137,P=0.017];术后12个月,2组患者Neer肩关节评分比较,差异无统计学意义[(94.75±7.85)分,(92.36±6.27)分,t=1.541,P=0.435]。(3)安全性。肩峰下前外侧入路组1例出现螺钉松动,胸大肌三角肌入路组1例出现螺钉松动、1例出现肱骨头缺血性坏死、2例出现肩峰下撞�Objective：To compare the clinical curative effects and safety of locking plate internal fixation through subacromial anterolateral approach versus ectopectoralis - deltoid approach for treatment of 2 - part and 3 - part proximal humeral fractures in the aged. Methods： The medical records of 72 aged patients with 2 - part or 3 - part proximal humeral fractures were analyzed retrospectively. Thirty- seven patients were treated with locking plate internal fixation through subacromial anterolateral approach（ group A） ,while the others were treated with locking plate internal fixation through ectopectoralis -deltoid approach （group B）. The patients consisted of 31 males and 41 females and they ranged in age from 61 to 92 years（ Median = 73 yrs） and ranged in disease course from 1 to 7 days（ Median = 3 days）. The fractures belonged to Neer 2 -part（ 33 ）and 3 -part（ 39 ）proximal humeral fractures. The operative time, intraoperative blood loss, hos- pital stay, fracture healing time and complications were compared between the 2 groups. The Neer shoulder scores were also compared be- tween the 2 groups at 3,6 and 12 months after the surgery respectively. Results：The operative time, hospital stay and fracture healing time were shorter in group A compared to group B （52.31 ＋/- 21.34 vs 87.52 ＋/- 22.71 min, t = 2. 874, P = 0. 023 ; 10.21 ＋/- 3. 17 vs 14.21 ＋/-2.91 days,t = 1. 952,P =0.037;11.73 ＋/-3.51 vs 14.18 ＋/-2.90 weeks,t =2. 357,P =0.047） ,and the intraoperative blood loss were less in group A compared to group B（87.93 ＋/-2.74 vs 153.24 ＋/-3.51 ml,t = -3. 237 ,P = 0. 017 ）. There was interaction between time factor and group factor（ F = 12. 734, P = 0. 000 ）. There was statistical difference in the Neer shoulder scores between the 2 groups in general, in other words, there was group effect （ t = 2.714, P = 0.032 ）. There was statistical difference in Neer shoulder scores be- tween different postoperative time points, in other words, there was time effect （

关 键 词：肩骨折 肱骨骨折 骨折固定术 内 内固定器 锁定钢板 手术入路 老年人 临床试验 

分 类 号：R687.3[医药卫生—骨科学]