改良肩外侧入路结合锁定接骨板治疗肱骨近端骨折的效果观察  

Effect of proximal humeral fractures with modified lateral shoulder approach combined with locking plate

作　　者：侯建伟[1] 王晓东[1] 谢仁国[2] 王岩松[1] HOU Jianwei;WANG Xiaodong;XIE Renguo;WANG Yansong(Department of Orthopedics,Nantong Third Hospital Affiliated to Nantong University,Nantong 226006;Trauma Center,Shanghai General Hospital)

机构地区：[1]南通大学附属南通第三医院骨科,南通226006 [2]上海市第一人民医院创伤中心

出　　处：《南通大学学报（医学版）》2022年第1期28-32,共5页Journal of Nantong University(Medical sciences)

基　　金：南通市科技计划项目资助(MSZ18220)。

摘　　要：目的:探讨应用改良肩关节外侧入路结合锁定加压接骨板固定技术治疗成人肱骨近端骨折的临床效果。方法:自2015年8月—2019年5月南通大学附属南通第三医院骨科收治40例年龄≤65岁的新鲜成人肱骨近端骨折患者,其中微创组20例,采用改良肩关节外侧入路;常规组20例,采用传统三角肌胸大肌入路。比较两组患者手术时间、术中出血量、骨折愈合时间、术中及术后并发症,以及术后1、3个月和末次随访时肩关节Constant-Murley功能评分、美国肩肘外科医师(American shoulder and elbow surgeons,AESE)结果评分。结果:两组患者的平均随访时间分别为(15.3±1.1)、(16.2±2.2)个月,差异无统计学意义(P>0.05)。微创组术中出血量、手术时间、骨折愈合时间均明显优于常规组(均P<0.05)。术后1、3个月微创组患者Constant-Murley评分[(55.8±5.3)、(82.0±4.8)分],AESE评分[(60.7±5.0)、(75.1±5.7)分]均优于常规组Constant-Murley评分[(40.3±5.1)、(78.1±6.9)分],AESE评分[(52.3±6.1)、(71.4±13.2)分](均P<0.05)。但末次随访时微创组患者Constant-Murley评分、AESE评分[(85.6±5.1)、(83.4±12.2)分]与常规组[(84.7±5.2)、(82.8±11.0)分]比较差异无统计学意义(P>0.05)。常规组术中出现头静脉损伤2例。两组均未发生腋神经损伤、复位丢失、骨不连、肱骨头坏死等并发症。结论:应用改良肩关节外侧入路结合锁定加压接骨板固定技术治疗成人肱骨近端骨折在手术创伤、肩关节功能恢复方面较传统入路具有明显优势。Objective:To investigate the clinical effect of modified lateral approach of shoulder joint combined with locking compression plate fixation in the treatment of adult proximal humeral fractures.Methods:From August 2015 to May 2019,40 fresh adult proximal humeral fractures aged≤65 years were treated in the Department of Orthopedics,Nantong Third Hospital Affiliated to Nantong University.In the minimally invasive group,20 patients were treated with an improved lateral approach of shoulder joint.In the conventional group,20 patients were treated with the traditional deltoid pectoralis major approach.The operative time,intraoperative blood loss,fracture healing time,intraoperative and postoperative complications of the two groups were analyzed and compared.Shoulder Constant-Murley function score and American shoulder and elbow surgeons(AESE)outcome score at 1,3 months and the last follow-up.Results:The mean follow-up time of patients in the two groups was(15.3±1.1)and(16.2±2.2)months,respectively,and the difference was not statistically significant(P>0.05).The amount of intraoperative blood loss,operation time and fracture healing time in the minimally invasive group were significantly better than those in the conventional group,with statistically significant differences(all P<0.05).The shoulder Constant-Murley score[(55.8±5.3),(82.0±4.8)]and AESE score[(60.7±5.0),(75.1±5.7)]at 1 months and 3 months in the minimally invasive group were significantly higher than the shoulder Constant-Murley function score in the conventional group[(40.3±5.1),(78.1±6.9)],and AESE score[(52.3±6.10),(71.4±13.2)].However,no significant difference(P>0.05)in the Constant-Murley score and AESE score were observed between the minimally invasive group[(84.7±5.2),(83.4±12.2)]and conventional group[(84.7±5.2),(82.8±11.0)]during the last follow-up.In the conventional group,2 cases had cephalic vein injury during operation.There were no complications such as axillary nerve injury,loss of reduction,bone nonunion and humeral head nec

关 键 词：肱骨近端骨折 骨折内固定术 微创入路 

分 类 号：R683.41[医药卫生—骨科学]