改良肩关节前上方入路结合锁定接骨板治疗肱骨近端骨折

目的:评价改良肩关节前上方入路结合肱骨近端锁定接骨板治疗肱骨近端骨折的优越性。方法:分别采取改良肩前上方入路(A组)、肩峰下外侧入路(B组)和肩关节前内侧入路(C组)结合锁定近端肱骨接骨板固定治疗72例肱骨近端骨折患者。比较各组患者手术时间、术中出血量及术后引流量,术后1周疼痛视觉模拟评分(Visual analogue scale,VAS),术后3月Constan-Murley评分和骨折愈合率之间的差异。结果:A组和B组手术时间无差异(P0.05),二者均大于C组(P0.05);A组和B组术中出血量、术后引流量及术后1周VAS评分无差异(P0.05),二者均小于C组(P0.05);术后3月,A组和B组Constan-Murley评分、骨折愈合率无差异(P0.05;P0.0125),二者均大于C组(P0.05;P0.0125)。结论:改良肩前上方入路治疗肱骨近端骨折具有创伤小的特点,同时具备术中改变切口扩大显露的灵活性,是一种治疗肱骨近端骨折安全有效的手术入路。

Advanced Upper Anterioracromial Approach Combined withLockingProximal Humeral Plate Fixation for the Treatment of ProximalHumeral Fractures

Objective:To investigate the superiorityof advanced upper anterioracromial approach combined with locking proximalhumeral plate used for proximal humeral fractures.Methods:72 proximal humeral fracture patients were treated with advanced upper anterioracromialapproach (group A), deltoid-split approach (group B) and deltopectoral approach (group C) combined with locking proximalhumeral plate (LPHP) fixation. The operation time, intraoperative bleeding volume, amount of postoperative drainage, visual analoguescale one week postoperatively, Constan-Murley scale and fracture healing rate 3 months after the operation were documented andstatistically analyzed.Results:The operation time between group A and B had no statistical difference (P>0.05), which was higher thangroup C (P<0.05); Intraoperative bleeding volume, amount of postoperative drainage and visual analogue scale one week postoperativelybetween group A and B had no statistical difference (P>0.05), which was lower than group C (P<0.05); Three weeks after the operation,Constan-Murley scale and fracture healing rate between groupA and B had no statistical difference (P>0.05 and P>0.0125 respectively),which was higher than groupC (P<0.05 and P<0.0125 respectively).Conclusion:Using advanced upper anterioracromial approach forthe treatment of proximal humeral fracture is minimally invasive. Meanwhile, surgeons can extend this approach easily when necessary.It is an ideal operative approach for proximal humeral fractures.