改良肩峰前下双切口钢板内固定治疗外展嵌插型肱骨近端骨折的早期疗效  

Short-term clinical efficacy of modified anterior subacromial approach plate internal fixation in the treatment of valgus impactedproximal humeral fractures

作　　者：叶友友 俞张剑 林焱斌 庄研 许阳凯 熊国胜 涂少臣 Ye Youyou;Yu Zhangjian;Lin Yanbin;Zhuang Yan;Xu Yangkai;Xiong Guosheng;Tu Shaochen(Trauma Orthopaedics,Fuzhou Second General Hospital,School of Clinical Medicine,Fujian Medical University,Fuzhou 350007,China)

机构地区：[1]福州市第二总医院创伤骨科(福建医科大学临床医学部),福州350007

出　　处：《中华骨科杂志》2024年第7期477-484,共8页Chinese Journal of Orthopaedics

基　　金：福州市科技计划项目(2021-S-161);福建省创伤骨科急救与康复临床医学研究中心(2020Y2014);福州市卫生健康科技创新平台建设项目(2019-S-wp2)。

摘　　要：目的探讨改良肩峰前下双切口钢板内固定治疗外展嵌插型三、四部分肱骨近端骨折的临床疗效。方法回顾性分析福州市第二总医院于2018年11月至2021年11月期间采用改良肩峰前下双切口钢板内固定治疗的35例外展嵌插型三、四部分肱骨近端骨折患者的病历资料,男15例、女20例,年龄(61.7±7.8)岁(范围40~73岁)。根据Neer分型,三部分骨折17例、四部分骨折18例。采用改良肩峰前下双切口入路,自三角肌前束自然间隙进入,对骨折端进行复位及钢板内固定。统计手术时间、切口长度、X线透视时间、随访时间和肩关节Constant-Murley评分、骨折愈合时间、疼痛视觉模拟评分(visual analogue scale,VAS)及肱骨颈干角等。记录术中及术后并发症的发生情况。结果35例患者均顺利完成手术,切口长度为(8.1±0.3)cm(范围7.6~9.0cm),手术时间为(87.3±9.3)min(范围70~110min)。术中X线透视时间为(6.6+0.3)s,Neer分型三部分骨折为(6.3±0.2)s、四部分骨折为(6.8±0.2)s,差异有统计学意义(t=6.350,P<0.001)。随访时间为(22.1±5.8)个月(范围14~31个月)。骨折愈合时间为(11.8±1.4)周(范围10~15周)。末次随访时VAS评分为(1.6±0.7)分(范围1~3分);肩关节Constant-Murley评分为(89.6±2.9)分(范围84~95分);肱骨颈干角为133.4°±3.1°(范围128°~138),Neer分型三部分骨折为133.6°±3.5°四部分骨折为133.3°±2.8°差异无统计学意义(t=0.288,P=0.075)。未观察到肱骨头坏死、骨折部位内翻塌陷、腋神经损伤等并发症。结论改良肩峰前下双切口钢板内固定治疗外展嵌插型三、四部分肱骨近端骨折具有创伤小、安全有效的特点,可获得良好的早期疗效。Objective To evaluate the clinical efficacy of modified anterior subacromial approach plate internal fixation for three-or four-part valgus impacted proximal humeral fractures.Methods A retrospective analysis of 35 patients treated be-tween November 2018 and November 2021 at Fuzhou Second General Hospital was performed,including 15 males and 20 females aged 61.7±7.8 years(range:40 to 73 years).Patients were classified under the Neer system;17 had 3-part fractures and 18 had 4-part fractures.The modified approach accessed the fracture site via the natural interval of the deltoid anterior bundle,facilitating fracture reduction and fixation using a plate.Operative time,incision length,intraoperative fluoroscopy time,follow-up duration,Constant-Murley score,fracture healing time,visual analogue scale(VAS)for pain,and humeral neck-shaft angle were assessed.Intraoperative and postoperative complications were also recorded.Results All patients underwent successful surgery,with an average incision length of 8.1±0.3 cm(range,7.6-9.0 cm)and intraoperative fluoroscopy time of 6.6±0.3 seconds(3-part fractures:6.3±0.2 s,4-part fractures:6.8±0.2 s,t=6.350,P<0.001).Follow-up averaged 22.1±5.8 months(range,14-31 months).Fracture healing occurred in 11.8±1.4 weeks(range,10-15 weeks).At the final assessment,the VAS score was 1.6+0.7(range,1-3),the Constant-Murley score was 89.6±2.9(range,84-95),and the humeral neck-shaft angle was 133.4°±3.1°(range,128°-138°;3-part fractures:133.6°±3.5,4-part fractures:133.3°±2.8°,t=0.288,P=0.075).No complications such as avascular necrosis of the hu-meral head,varus collapse of the fracture site,or axillary nerve injury were recorded.Conclusion The modified anterior subacro-mial approach plate internal fixation is a minimally invasive,safe,and effective treatment for valgus impacted three-and four-part proximal humeral fractures,demonstrated by excellent surgical outcomes and absence of major complications.

关 键 词：肩骨折 骨折固定术 内 治疗结果 手术入路 

分 类 号：R687.3[医药卫生—骨科学]