郭文龙

[摘要]目的 探討经三角肌外侧纵行分开入路锁定钢板内固定治疗肱骨近端骨折的效果。方法 选取2011年3月～2016年5月我院收治的65例肱骨近端骨折患者作为研究对象，按手术入路的不同分为治疗组（32例）和常规组（33例）。治疗组采用经三角肌外侧纵行分开入路锁定钢板内固定术，常规组患者采用经胸大肌-三角肌间隙入路锁定钢板内固定术。观察两组患者的术中出血量、手术时间、骨折愈合时间、手术并发症，并比较术后3个月两组患者的Constant评分。结果 治疗组和常规组患者的术中出血量[（90.2±29.9）、（240.1±64.9）ml]、骨折愈合时间[（79.9±1.7）、（91.0±2.2）d]比较，差异有统计学意义（P<0.05），治疗组患者的手术时间[（71.9±14.9）min]与常规组[（69.8±15.7）min]比较，差异无统计学意义（P>0.05）。治疗组患者术后并发症的发生率（6.3%）低于常规组（15.2%），差异有统计学意义（χ2=3.85，P<0.05）。治疗组患者术后3个月的Constant评分[（85.1±6.9）分]优于常规组[（74.9±7.0）分]，差异有统计学意义（P<0.05）。结论 经三角肌外侧纵行分开入路治疗肱骨近端骨折，具有术中出血量小、骨折愈合时间短、肩关节功能早期恢复较好及术后并发症少等优点，值得临床推广。

[关键词]经三角肌外侧纵行分开入路；经胸大肌-三角肌间隙入路；肱骨近端骨折； 锁定钢板内固定

[中图分类号] R683.41 [文献标识码] A [文章编号] 1674-4721（2018）2（a）-0097-03

[Abstract]Objective To explore the efficacy of locking plate fixation with deltoid lateral separate approach in the treatment of proximal humeral fractures.Methods 65 cases with proximal humerus fracture treated in our hospital from March 2011 to May 2016 were selected as the subjects，and divided into the observation group （32 cases） and control group （33 cases） according to the different operative approaches.The patients in the observation group were treated with locking plate fixation by dehopectoral approach，and the patients in the control group were treated with locking plate fixation by lateral deltoid approach approach.The intraoperative blood loss，operation time，fracture healing time，postoperative complication rate，Constant scores of shoulder function at different times after operation were observed in two groups.Results The intraoperative blood loss of the observation group was （90.2±29.9） ml，and the control group was （240.1±64.9） ml.The fracture healing time of two groups was （[79.9±1.7]、[91.0±2.2] d）.The difference between the two groups was statistically significant （P<0.05）.There was no significant difference between the observation group （[71.9±14.9] min） and the control group （[69.8±15.7] min） in the operation time（P>0.05）.The incidence of postoperative complications in the observation group （6.3%） was lower than that in the control group （15.2%），the difference was statistically significant（P<0.05）.Constant scores in the observation group were better than those in the control group at 3 months after operation，the difference was statistically significant （P<0.05）.Conclusion The lateral deltoid approach with locking plate fixation has advantages with dehopectoral approach in treatment of proximal humeral fractures，less intraoperative bleeding，shorter fracture healing time，faster recovery of shoulder function and less postoperative complications，which is worth a wide application.

[Key words]Deltoid lateral separate approach；Dehopectoral approach；Proximal humeral fractures；Locking plate fixation

肱骨近端骨折是一种常见的骨折类型，发病率呈现逐渐增高的趋势，占全身骨折的4%～5%[1]，临床中对于移位较明显的肱骨近端骨折多采用手术内固定治疗[2-3]，随着成角稳定钢板的应用，肱骨近端骨折患者的预后得到了极大改善。胸大肌-三角肌间隙入路是治疗该类型骨折的标准入路，但其手术入路对机体的创伤较大，可导致术后感染、肩关节僵硬、骨折延迟愈合等[4-5]。经三角肌外侧纵行分开入路治疗肱骨近端骨折因其微创临床应用越来越广泛。但有关两种手术入路临床效果优劣的相关文献分析较少，本文选取我院收治的65例肱骨近端骨折患者的临床资料进行分析，旨在探讨两种入路锁定钢板内固定治疗肱骨近端骨折的效果，为临床治疗方案的选择提供依据，现报道如下。……