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[1]姚華海,孫龍?zhí)?崔龍慷,等.肩峰下前外側(cè)入路與胸大肌三角肌入路鎖定鋼板內(nèi)固定治療老年肱骨近端二、三部分骨折的對(duì)比研究[J].中醫(yī)正骨,2017,29(09):1-6.
　YAO Huahai,SUN Longtai,CUI Longkang,et al.A comparative study of locking plate internal fixation through subacromial anterolateral approach versus ectopectoralis-deltoid approach for treatment of Neer 2-part and 3-part proximal humeral fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(09):1-6.
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肩峰下前外側(cè)入路與胸大肌三角肌入路鎖定鋼板內(nèi)固定治療老年肱骨近端二、三部分骨折的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年09期
頁碼:
1-6
欄目:
臨床研究
出版日期:
2017-09-20

文章信息/Info

Title:
A comparative study of locking plate internal fixation through subacromial anterolateral approach versus ectopectoralis-deltoid approach for treatment of Neer 2-part and 3-part proximal humeral fractures in the aged
作者:
姚華海1; 崔龍慷1; 王曉洛1; 吳連國2
1.浙江中醫(yī)藥大學(xué),浙江 杭州 310053; 2.浙江中醫(yī)藥大學(xué)附屬第二醫(yī)院,浙江 杭州 310005
Author(s):
YAO Huahai1; SUN Longtai1; CUI Longkang1; WANG Xiaoluo1; WU Lianguo2
1.Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang,China 2.The Second Affiliated Hospital of Zhengjiang Chinese Medical University,Hangzhou 310005,Zhejiang,China
關(guān)鍵詞:
肩骨折;  肱骨骨折;  骨折固定術(shù); 內(nèi);  內(nèi)固定器;  鎖定鋼板;  手術(shù)入路;  老年人;  臨床試驗(yàn)
Keywords:
Key words shoulder fractures;  humeral fractures;  fracture fixation; internal;  internal fixators;  locking plate;  operative approach;  aged;  clinical trial
摘要:
目的:比較肩峰下前外側(cè)入路與胸大肌三角肌入路鎖定鋼板內(nèi)固定治療老年肱骨近端二、三部分骨折的臨床療效和安全性。方法:回顧性分析72例老年肱骨近端二、三部分骨折患者的病例資料,其中采用肩峰下前外側(cè)入路鎖定鋼板內(nèi)固定37例,采用胸大肌三角肌入路鎖定鋼板內(nèi)固定35例。男31例,女41例。年齡61～92歲,中位數(shù)73歲。肱骨近端骨折Neer二部分骨折33例,三部分骨折39例。受傷至手術(shù)時(shí)間1～7 d,中位數(shù)3 d。比較2組患者手術(shù)時(shí)間、術(shù)中出血量、住院時(shí)間、骨折愈合時(shí)間及并發(fā)癥發(fā)生情況,并分別比較術(shù)后3個(gè)月、6個(gè)月及12個(gè)月時(shí)2組患者的Neer肩關(guān)節(jié)評(píng)分。結(jié)果:①一般指標(biāo)。肩峰下前外側(cè)入路組的手術(shù)時(shí)間、住院時(shí)間、骨折愈合時(shí)間均短于胸大肌三角肌入路組[(52.31±21.34)min,(87.52±22.71)min,t=2.874,P=0.023;(10.21±3.17)d,(14.21±2.91)d,t=1.952,P=0.037;(11.73±3.51)周,(14.18±2.90)周,t=2.357,P=0.047],術(shù)中出血量小于胸大肌三角肌入路組[(87.93±2.74)mL,(153.24±3.51)mL,t=-3.237,P=0.017]。②Neer肩關(guān)節(jié)評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=12.734,P=0.000); 2組患者Neer肩關(guān)節(jié)評(píng)分總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(t=2.714,P=0.032); 術(shù)后不同時(shí)間點(diǎn)間Neer肩關(guān)節(jié)評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=297.094,P=0.000); 2組患者Neer肩關(guān)節(jié)評(píng)分隨時(shí)間均呈增加趨勢(shì),但是2組的增加趨勢(shì)不完全一致; 術(shù)后3個(gè)月、術(shù)后6個(gè)月,肩峰下前外側(cè)入路組Neer肩關(guān)節(jié)評(píng)分均高于胸大肌三角肌入路組[(74.53±16.35)分,(63.25±15.27)分,t=2.173,P=0.023;(87.74±5.35)分,(74.83±6.58)分,t=3.137,P=0.017]; 術(shù)后12個(gè)月,2組患者Neer肩關(guān)節(jié)評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義[(94.75±7.85)分,(92.36±6.27)分,t=1.541,P=0.435]。③安全性。肩峰下前外側(cè)入路組1例出現(xiàn)螺釘松動(dòng),胸大肌三角肌入路組1例出現(xiàn)螺釘松動(dòng)、1例出現(xiàn)肱骨頭缺血性壞死、2例出現(xiàn)肩峰下撞擊征; 2組患者安全性比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.984,P=0.145)。結(jié)論:對(duì)于老年肱骨近端二、三部分骨折而言,肩峰下前外側(cè)入路鎖定鋼板內(nèi)固定與胸大肌三角肌入路鎖定鋼板內(nèi)固定在安全性方面無明顯差異,但前者具有手術(shù)時(shí)間短、術(shù)中出血量少、住院時(shí)間短、骨折愈合快、肩關(guān)節(jié)功能恢復(fù)快等優(yōu)點(diǎn),值得臨床推廣應(yīng)用。
Abstract:
ABSTRACT Objective:To compare the clinical curative effects and safety of locking plate internal fixation through subacromial anterolateral approach versus ectopectoralis-deltoid approach for treatment of 2-part and 3-part proximal humeral fractures in the aged.Methods:The medical records of 72 aged patients with 2-part or 3-part proximal humeral fractures were analyzed retrospectively.Thirty-seven patients were treated with locking plate internal fixation through subacromial anterolateral approach(group A),while the others were treated with locking plate internal fixation through ectopectoralis-deltoid approach(group B).The patients consisted of 31 males and 41 females and they ranged in age from 61 to 92 years(Median=73 yrs)and ranged in disease course from 1 to 7 days(Median=3 days).The fractures belonged to Neer 2-part(33)and 3-part(39)proximal humeral fractures.The operative time,intraoperative blood loss,hospital stay,fracture healing time and complications were compared between the 2 groups.The Neer shoulder scores were also compared between the 2 groups at 3,6 and 12 months after the surgery respectively.Results:The operative time,hospital stay and fracture healing time were shorter in group A compared to group B(52.31+/-21.34 vs 87.52+/-22.71 min,t=2.874,P=0.023; 10.21+/-3.17 vs 14.21+/-2.91 days,t=1.952,P=0.037; 11.73+/-3.51 vs 14.18+/-2.90 weeks,t=2.357,P=0.047),and the intraoperative blood loss were less in group A compared to group B(87.93+/-2.74 vs 153.24+/-3.51 ml,t=-3.237,P=0.017).There was interaction between time factor and group factor(F=12.734,P=0.000).There was statistical difference in the Neer shoulder scores between the 2 groups in general,in other words,there was group effect(t=2.714,P=0.032).There was statistical difference in Neer shoulder scores between different postoperative time points,in other words,there was time effect(F=297.094,P=0.000).The Neer shoulder scores presented a time-dependent increasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the increasing trend of Neer shoulder scores.The Neer shoulder scores were higher in group A compared to group B at 3 and 6 months after the surgery(74.53+/-16.35 vs 63.25+/-15.27 points,t=2.173,P=0.023; 87.74+/-5.35 vs 74.83+/-6.58 points,t=3.137,P=0.017).There was no statistical difference in the Neer shoulder scores between the 2 groups at 12 months after the surgery(94.75+/-7.85 vs 92.36+/-6.27 points,t=1.541,P=0.435).After the surgery,screw loosening(1 patient)was found in group A,while screw loosening(1 patient),ischemic necrosis of humeral head(1 patient)and subacromial impingement syndrome(2 patients)were found in group B.There was no statistical difference in safety between the 2 groups(χ2=0.984,P=0.145).Conclusion:There is no significant difference in the safety between subacromial anterolateral approach and ectopectoralis-deltoid approach in locking plate internal fixation for treatment of Neer 2-part and 3-part proximal humeral fractures in the aged,however,the former has the advantages of shorter operative time,less intraoperative blood loss,shorter hospital stay,faster fracture healing and faster recovery of shoulder function,so it is worthy of popularizing in clinic.

參考文獻(xiàn)/References:

[1] MCKOY BE,BENSEN CV,HARTSOCK LA.Fractures about the shoulder:conservative management[J].Orthopedic Clinics of North America,2000,31(2):205-216. [2] ROBINSON CM,AMIN AK,GODLEY KC,et al.Modern perspectives of open reduction and plate fixation of proximal humerus fractures[J].J Orthop Trauma,2011,25(10):618-629. [3] 王棟,潘浩,賈高永,等.老年骨質(zhì)疏松性肱骨近端骨折分型及臨床治療進(jìn)展[J].中國中醫(yī)骨傷科雜志,2015(5):77-80. [4] 張國文.肱骨近端鎖定接骨板內(nèi)固定治療肱骨近端骨折[J].中醫(yī)正骨,2016,28(8):50-51. [5] 喻永新,尚如國.切開復(fù)位鎖定鋼板內(nèi)固定治療肱骨近端骨折[J].中醫(yī)正骨,2014,26(9):39-40. [6] NEER CS 2nd.Displaced proximal humeral fractures.I.Classification and evaluatio[J].J Bone Joint Surg Am,1970,52(6):1077-1089. [7] 中華醫(yī)學(xué)會(huì).臨床診療指南·骨科分冊(cè)[M].北京:人民衛(wèi)生出版社,2009:15-16. [8] 王亦璁.骨與關(guān)節(jié)損傷[M].4版.北京:人民衛(wèi)生出版社,2007:763. [9] CONBOY VB,MORRIS RW,KISS J,et al.An evaluation of the Constant-Murley shoulder assessment[J].J Bone Joint Surg Br,1996,78(2):229-232. [10] KANNUS P,PALVANEN M,NIEMI S,et al.Rate of proximal humeral fractures in older finnish women between 1970 and 2007[J].Bone,2009,44(4):656-659. [11] 向成浩,王詩波,明玉祥.內(nèi)側(cè)柱支撐重建結(jié)合鎖定鋼板內(nèi)固定治療老年肱骨近端骨折的臨床療效[J].中國矯形外科雜志,2015,23(4):289-294. [12] 方廣文,舒衡生,曾憲鐵,等.鎖定鋼板在肱骨近端骨折治療中的應(yīng)用(附21例報(bào)告)[J].中國矯形外科雜志,2009,17(8):575-577. [13] CADET ER,AHMAD CS.Hemiarthroplasty for three- and four-part proximal humerus fractures[J].J Am Acad Orthop Surg,2012,20(1):17-27. [14] GERBER C,SCHNEEBERGER AG,VINH TS.The arterial vascularization of the humeral head.An anatomical study[J].J Bone Joint Surg Am,1990,72(10):1486-1494. [15] GARDNER MJ,GRIFFITH MH,DINES JS,et al.The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus[J].Clin Orthop Relat Res,2005,434(434):123-129. [16] GARDNER MJ,BORAIAH S,HELFET DL.The anterolateral acromial approach for fractures of the proximal humerus[J].J Orthop Trauma,2008,22(2):132-137. [17] TINGART MJ,LEHTINEN J,ZURAKOWSKI D,et al.Proximal humeral fractures:regional differences in bone mineral density of the humeral head affect the fixation strength of cancellous screws[J].Journal of Shoulder and Elbow Surgery,2006,15(5):620-624.

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備注/Memo

備注/Memo:
基金項(xiàng)目:浙江省一流學(xué)科(B類)建設(shè)項(xiàng)目 通訊作者:吳連國 E-mail:[email protected]
更新日期/Last Update: 2018-02-23