杨波

【摘要】 目的：探讨不同入路锁定钢板内固定治疗肱骨近端骨折患者的效果。方法：选取2018年1月-2019年7月笔者所在医院肱骨近端骨折患者86例，依据随机数字表法分为两组，各43例。B组采用三角肌入路锁定钢板内固定，A组采用肩峰下入路鎖定钢板内固定。比较两组切口长度、术中出血量、手术时间、住院时间、骨折愈合时间、术前及术后3个月视觉模拟量表（VAS）评分、Constant-Murley肩关节功能评分、术后并发症发生率。结果：A组切口长度小于B组，术中出血量少于B组，手术时间、住院时间、骨折愈合时间均短于B组（P<0.05）;术后3个月，A组VAS评分低于B组，Constant-Murley肩关节功能评分高于B组（P<0.05）;A组术后并发症发生率为2.33%，低于B组的18.60%（P<0.05）。结论：采用肩峰下入路锁定钢板内固定治疗肱骨近端骨折患者，可缩短切口长度，减少术中出血量，缩短手术时间、住院时间、骨折愈合时间，缓解疼痛，促进肩关节功能恢复，降低术后并发症发生率。

【关键词】 肩峰下入路 三角肌入路 锁定钢板内固定 肱骨近端骨折 肩关节功能 术后并发症发生率

doi：10.14033/j.cnki.cfmr.2020.18.052 文献标识码 B 文章编号 1674-6805（2020）18-0-03

Clinical Effect of Locking Plate Internal Fixation in the Treatment of Proximal Humeral Fractures by Different Approaches/YANG Bo. //Chinese and Foreign Medical Research， 2020， 18（18）： -124

[Abstract] Objective： To investigate the effect of locking plate internal fixation in the treatment of proximal humeral fractures by different approaches. Method： A total of 86 patients with proximal humeral fractures in our hospital from January 2018 to July 2019 were selected and divided into two groups according to the random number table method， with 43 patients in each group. Locking plate internal fixation through deltoid approach was used in the group B， and locking plate internal fixation through subacromial approach was used in the group A. Incision length， intraoperative blood loss， operation time， hospital stay， fracture healing time， visual analogue scale （VAS） score， Constant-Murley shoulder joint function score before and 3 months after operation and incidence of postoperative complications were compared between the two groups. Result： The incision length of the group A was smaller than that of the group B， the intraoperative blood loss was less than that of the group B， the operation time， hospital stay and fracture healing time were shorter than those of the group B （P<0.05）. At 3 months after operation， VAS score in the group A was lower than that of the group B， and Constant-Murley shoulder joint function score was higher than that of the group B （P<0.05）. The incidence of postoperative complications in the group A was 2.33%， which was lower than 18.60% of the group B （P<0.05）. Conclusion： In the treatment of proximal humeral fractures with locking plate internal fixation through subacromial approach， the incision length can be shortened， the intraoperative blood loss can be reduced， the operation time， hospital stay and fracture healing time can be shortened， the pain can be alleviated， the shoulder joint function can be improved， and the incidence of postoperative complications can be reduced.

[Key words] Subacromial approach Deltoid approach Locking plate internal fixation Proximal humeral fracture Shoulder joint function Incidence of postoperative complications

First-authors address： Zigui County Peoples Hospital， Zigui 443600， China

肱骨近端骨折為临床中常见的上肢骨折，约占全身骨折的5%，车祸为造成此类骨折的主要原因。近年来随着交通事业的发展，肱骨近端骨折发生率呈上升趋势[1]。肱骨近端骨折可发生于任何年龄段，但多见于老年患者，常出现肩部肿胀、疼痛、活动受限等，部分患者伴有上肢麻木[2]。早期治疗肱骨近端骨折多使用石膏悬吊、肩手吊带等保守疗法，疗程较长，多数移位明显患者仍需采用手术治疗[3]。切开复位手术对机体损伤较大，术后恢复缓慢。而肩峰下入路锁定钢板内固定术的固定效果显著，在肱骨近端骨折治疗中优势突出。本研究选取笔者所在医院肱骨近端骨折患者86例，探讨不同入路锁定钢板内固定治疗效果，报道如下。

1 资料与方法

1.1 一般资料