摘要
目的：对比肩峰前外侧入路与胸大肌三角肌入路在肱骨近端Neer 2、3部分骨折手术治疗中的临床疗效.方法：回顾性分析2009年1月至2012年12月收治并获随访的49例肱骨近端Neer 2、3部分骨折患者的资料,其中肩峰前外侧入路组22例,男9例,女13例,平均年龄（63.2±7.6）岁;胸大肌三角肌入路组27例,男12例,女15例,平均年龄（62.9±7.0）岁.比较两组患者的手术时间、术中出血量与骨折愈合时间及术后并发症,术后3个月及1、2年时分别采用Constant-Murley评分和视觉模拟评分法（VAS）评定肩关节功能及患肩疼痛度.结果：所有患者术后获随访,时间24～41个月,平均34.5个月.肩峰前外侧入路组手术时间[（68.20±7.04） min]较胸大肌三角肌入路组[（75.81±13.70） min]短,术中出血量[（151.30±20.57） ml]少于胸大肌三角肌入路组[（242.10±37.25） ml],骨折愈合时间[（10.88±4.90）周]短于胸大肌三角肌入路组[（13.60±2.45）周].术后3个月,肩峰前外侧入路组Constant-Murley评分88.32±5.45,肩关节疼痛VAS评分0.41±0.63,均优于胸大肌三角肌入路组[（63.53±8.31）vs（1.65±1.02）].但术后1年及2年,两组Constant-Murley评分与肩关节疼痛VAS评分差异均无统计学意义.两组各有1例术后出现肱骨头高度丢失,胸大肌三角肌入路组另有l例肩峰下撞击、l例螺钉松动及2例骨折延迟愈合.两组均未发生腋神经损伤及肱骨头坏死和内固定断裂等并发症.结论：采用肩峰前外侧入路与胸大肌三角肌入路手术治疗肱骨近端Neer 2、3部分骨折最终均可获得满意的中期疗效,前者更具有创伤小、出血少、手术时间短、术后肩关节功能恢复及骨折愈合快等优点.
Objective：To compare clinical results of treating Neer two-and three-part of proximal humeral fractures between anterolateral acromial approach and deltopectoral approach.Methods：From January 2009 to December 2012,49 patients with Neer two-and three-part of proximal humeral fractures were treated with locked plate fixation.In anterolateral acromial approach group,there were 22 patients including 9 males and 13 females with an average of （63.2±7.6） years old,while 27 patients in deltopectoral approach including 12 males and 15 females with an average of （62.9±7.0） years old.Operative time,blood loss during operation,fracture healing time and complications were observed and compared,postoperative ConstantMurley scoring and VAS scoring were applied for evaluate function of shoulder joint and pain at 3 months,1 and 2 years respectively.Results：All patients were followed up from 24 to 41 months with an average of 34.5 months.Operative time,blood loss,fracture healing time in anterolateral acromial approach group was （68.20±7.04） min,（151.30±20.57） ml,（10.88±4.90） weeks respectively,and better than that of in deltopectoral approach group which was （75.81± 13.70） min,（242.10±37.25） ml and （13.60±2.45） weeks.Three months after operation,Constant-Murley scoring and VAS score in anterolateral acromial approach group was 88.32±5.45,0.41±0.63 and better that of in deltopectoral approach group which was 63.53±8.31,1.65±1.02.There was no significant differences between two groups in Constant-Murley scoring and VAS score at 1 and 2 years after operation.Each group has one case occurred loss of length humerus head height,and there was 1 case with subacromial impingement,1 case with bolt loose and 2 cases with delayed union in deltopectoral approach.No axillary nerve injury,humeral head necrosis and breakage of internal fixation occurred both of two groups.Conclusion：Both of anterolateral acromial approach and deltopectoral approach are effective in treating Neer two-and three-p
出处
《中国骨伤》
CAS
2014年第12期991-994,共4页
China Journal of Orthopaedics and Traumatology
关键词
肱骨骨折
近端
骨折固定术
内
病例对照研究
Humeral fractures,proximal
Fracture fixation,internal
Case-control studies
