胸大肌三角肌入路与经三角肌外侧入路治疗肱骨近端骨折的疗效分析  

Therapeutic effect analysis of pectoralis major deltoid approach and trans-deltoid lateral approach on proximal humeral fracture

作　　者：左楠 刘岩[1] 孙大辉[1] 刘哲闻 杨光[1] Zuo Nan;Liu Yan;Sun Dahui;Liu Zhewen;Yang Guang(Orthopaedic Center,The First Bethune Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院骨科中心·创伤骨科,长春130021

出　　处：《中华肩肘外科电子杂志》2023年第3期252-257,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：吉林省发改委基金(2023C043-1)。

摘　　要：目的对比通过胸大肌三角肌入路与经三角肌外侧入路锁定钢板内固定治疗肱骨近端骨折的临床疗效。方法回顾性分析自2018年1月至2022年10月,吉林大学第一医院创伤骨科采用锁定钢板治疗的NeerⅡ型和Ⅲ型肱骨近端骨折患者143例。根据手术入路的不同,分为胸大肌三角肌组和经三角肌外侧组。记录患者的手术时间、切口长度、末次随访时的肩关节功能Constant评分。结果对于NeerⅡ型骨折和NeerⅢ型骨折,经三角肌外侧组在手术时间和切口长度上,相比于胸大肌三角肌组都更有优势,差异具有统计学意义(P<0.05)。但在末次随访时,胸大肌三角肌组患者的Constant评分与经三角肌外侧组患者的Constant评分差异无统计学意义(P>0.05)。结论在治疗NeerⅡ型、Ⅲ型肱骨近端骨折时,经三角肌外侧入路相对于胸大肌三角肌入路具有切口小、手术时间短、术后恢复快的优势,但在远期的临床疗效上两者并无差异。Background In 1970,Neer first proposed the Neer classification of proximal humeral fractures.The traditional pectoralis major deltoid approach was often adopted with satisfactory results for the proximal humeral fracture requiring surgery.In recent years,with the concept of minimal invasion and rapid rehabilitation,the trans-deltoid lateral approach has been gradually accepted by more and more surgeons,but there are still some controversies on the selection of the two surgical approaches.Objective To compare the clinical efficacy of locking plate internal fixation by pectoralis major deltoid approach and trans-deltoid lateral approach in treating proximal humerus fracture.Methods A retrospective analysis was performed on 143 patients with Neer type II and type III proximal humeral fractures treated with locking plate fixation in the department of orthopedic and traumatology of the first bethune hospital of Jilin University from January 2018 to October 2022.According to the different surgical approaches,they were divided into pectoralis major deltoid group and trans-deltoid lateral group.The operative time,incision length,and Constant-Murley score of shoulder joint function at the last follow-up were recorded.Results For Neer type II and type III fractures,the trans-deltoid lateral group had more operation time and incision length advantages than those of the pectoralis major deltoid group,and the difference was statistically significant(P<0.05).However,at the last follow-up,there was no significant difference in the Constant-Murley score between the pectoralis major deltoid group and the trans-deltoid lateral group(P>0.05).Conclusion In treating Neer type II and type III proximal humeral fractures,the trans-deltoid lateral approach has the advantages of smaller incision,shorter operation time,and faster postoperative recovery compared with the pectoralis major deltoid approach.Still,there is no difference in long-term clinical efficacy.

关 键 词：肱骨近端骨折 锁定钢板 内固定 胸大肌三角肌 经三角肌外侧 

分 类 号：R687.3[医药卫生—骨科学]