改良肩关节外侧入路手术治疗肱骨近端骨折的临床研究  

Clinical study on the treatment of proximal humeral fractures through a modified lateral approach to the shoulder

作　　者：段添栋 刘伟[1] Duan Tiandong;Liu Wei(Department of Orthopedics,Zhoushan Branch,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Zhoushan 316000,Zhejiang Province,China)

机构地区：[1]上海交通大学医学院附属瑞金医院舟山分院骨科,舟山316000

出　　处：《中国基层医药》2023年第5期724-729,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨改良肩关节外侧入路手术治疗肱骨近端骨折的临床价值。方法选取上海交通大学医学院附属瑞金医院舟山分院2018年5月至2022年5月诊治的肱骨近端骨折患者64例,采用随机数字表法分为观察组、对照组各32例。观察组采用改良肩关节外侧入路手术,对照组采用肩关节前内侧入路手术。观察两组围术期指标(手术时间、术中出血量、术后引流量、住院时间、切口长度),比较两组术前、术后1周、术后3个月视觉模拟评分法(VAS)评分、Constant-Murley肩功能评分及术前、术后3个月肩关节活动度,观察两组并发症发生情况。结果观察组手术时间、术中出血量、术后引流量、住院时间、切口长度均短于、少于对照组(t=7.42、26.85、10.90、2.73、10.59,均P<0.05);术后1周、术后3个月,观察组VAS评分均低于对照组(t=5.80、6.06,均P<0.001);术后1周、术后3个月,观察组Constant-Murley评分分别为(62.96±12.05)分、(74.96±14.52)分,均高于对照组的(56.74±9.62)分、(67.88±12.25)分(t=2.28、2.10,均P<0.05);术后,观察组肩关节前屈、后伸、外旋、内旋等活动度均大于对照组(t=2.54、3.19、2.40、4.00,均P<0.05);观察组并发症发生率为6.25%(2/32),低于对照组的28.13%(9/32)(χ^(2)=5.39,P<0.05)。结论改良肩关节外侧入路治疗肱骨近端骨折效果显著,既能改善肩关节功能,又能缩短手术时间及降低并发症发生率。Objective To investigate the clinical value of the modified lateral approach to the shoulder for the treatment of proximal humeral fractures.Methods A total of 64 patients with proximal humeral fractures who received treatment in Zhoushan Branch,Ruijin Hospital,Shanghai Jiaotong University School of Medicine from May 2018 to May 2022 were included in this study.They were randomly divided into observation and control groups(n=32/group).The observation group was treated using a modified lateral approach to the shoulder.The control group was treated using the anteromedial approach to the shoulder.Perioperative indexes(operation time,intraoperative blood loss,postoperative drainage volume,hospital stay,and incision length)were compared between the two groups.Before surgery,1 week and 3 months after surgery,the visual analogue scale score and the Constant-Murley shoulder assessment score were compared between the two groups.Before surgery and 3 months after surgery,the shoulder range of motion was compared between the two groups.The incidence of complications was also compared between the two groups.Results The operation time,intraoperative blood loss,postoperative drainage volume,hospital stay,and incision length in the observation group were shorter or lower than those in the control group(t=7.42,26.85,10.90,2.73,10.59,all P<0.05).At 1 week and 3 months after surgery,the visual analogue scale score in the observation group was significantly lower than that in the control group(t=5.80,6.06,both P<0.001).At 1 week and 3 months after surgery,the Constant-Murley shoulder assessment score in the observation group was(62.96±12.05)points and(74.96±14.52)points,respectively,which were significantly higher than(56.74±9.62)points and(67.88±12.25)points in the control group(t=2.28,2.10,both P<0.05).After surgery,the range of motion of the shoulder joint in the observation group was greater than that in the control group,including forward flexion,backward extension,external rotation,and internal rotation(t=2.54,3.19,2.40,4.

关 键 词：肱骨骨折 肩关节 肩关节外侧入路 围手术期 疼痛测定 肩关节功能 手术后并发症 疗效比较研究 

分 类 号：R687.3[医药卫生—骨科学]