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[1]翁建東,周鵬鶴.肩關節(jié)外側(cè)入路與胸大肌三角肌入路鎖定加壓接骨板內(nèi)固定治療老年肱骨近端骨折的對比研究[J].中醫(yī)正骨,2020,32(06):22-26.
　WENG Jiandong,ZHOU Penghe.A comparative study of locking compression plate internal fixation through shoulder lateral approach versus ectopectoralis-deltoid approach for treatment of proximal humeral fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(06):22-26.
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肩關節(jié)外側(cè)入路與胸大肌三角肌入路鎖定加壓接骨板內(nèi)固定治療老年肱骨近端骨折的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年06期
頁碼:
22-26
欄目:
臨床研究
出版日期:
2020-06-20

文章信息/Info

Title:
A comparative study of locking compression plate internal fixation through shoulder lateral approach versus ectopectoralis-deltoid approach for treatment of proximal humeral fractures in the aged
作者:
翁建東; 周鵬鶴
(諸暨市第三人民醫(yī)院,浙江諸暨311800)
Author(s):
WENG Jiandong; ZHOU Penghe
The Third People’s Hospital of Zhuji City,Zhuji 311800,Zhejiang,China
關鍵詞:
肩骨折;  肱骨骨折;  骨折固定術; 內(nèi);  手術入路;  老年人
Keywords:
shoulder fractures;  humeral fractures;  fracture fixation; internal;  operative approach;  aged
摘要:
目的:比較肩關節(jié)外側(cè)入路與胸大肌三角肌入路鎖定加壓接骨板內(nèi)固定治療老年肱骨近端骨折的臨床療效及安全性。方法:回顧性分析80例老年肱骨近端骨折患者的病例資料,其中采用肩關節(jié)外側(cè)入路鎖定加壓接骨板內(nèi)固定治療40例(肩關節(jié)外側(cè)入路組),采用胸大肌三角肌入路鎖定加壓接骨板內(nèi)固定治療40例(胸大肌三角肌入路組)。男49例,女31例。年齡62～74歲,中位數(shù)68歲。按照肱骨近端骨折的Neer分型標準,二部分骨折24例、三部分骨折41例、四部分骨折15例。受傷至手術時間3～19 h,中位數(shù)11 h。比較2組患者的切口長度、術中出血量、手術時間、Constant-Murley肩關節(jié)功能評分及并發(fā)癥發(fā)生情況,并采用Neer肩關節(jié)評分標準評價綜合療效。結(jié)果:肩關節(jié)外側(cè)入路組的切口長度及手術時間均短于胸大肌三角肌入路組[(6.94±1.28)cm,(13.94±2.67)cm,t=14.952,P=0.000;(66.73±17.45)min,(91.14±20.62)min,t=5.715,P=0.000],術中出血量少于胸大肌三角肌入路組[(124.54±50.37)mL,(303.41±66.21)mL,t=13.598,P=0.000]。術前2組患者的Constant-Murley肩關節(jié)功能評分比較,差異無統(tǒng)計學意義(t=0.286,P=0.776); 術后3個月,2組患者的Constant-Murley肩關節(jié)功能評分均較術前增高[(40.64±5.38)分,(82.66±6.45)分,t=31.641,P=0.000;(40.98±5.26)分,(75.52±5.67)分,t=28.245,P=0.000],且肩關節(jié)外側(cè)入路組的Constant-Murley肩關節(jié)功能評分高于胸大肌三角肌入路組(t=5.258,P=0.000)。術后6個月,肩關節(jié)外側(cè)入路組綜合療效優(yōu)28例、良9例、可3例,胸大肌三角肌入路組綜合療效優(yōu)19例、良8例、可10例、差3例,肩關節(jié)外側(cè)入路組的綜合療效優(yōu)于胸大肌三角肌入路組(Z=-2.511,P=0.012)。肩關節(jié)外側(cè)入路組1例出現(xiàn)切口感染,胸大肌三角肌入路組5例出現(xiàn)切口感染、3例出現(xiàn)肱骨頭無菌性壞死、1例出現(xiàn)螺釘松動,肩關節(jié)外側(cè)入路組的并發(fā)癥發(fā)生率低于胸大肌三角肌入路組(χ2=7.314,P=0.007)。結(jié)論:采用肩關節(jié)外側(cè)入路鎖定加壓接骨板內(nèi)固定治療老年肱骨近端骨折,比采用胸大肌三角肌入路的切口長度及手術時間短、術中出血量少、肩關節(jié)功能及綜合療效好、安全性高。
Abstract:
Objective:To compare the clinical curative effects and safety of locking compression plate internal fixation through shoulder lateral approach versus ectopectoralis-deltoid approach for treatment of proximal humeral fractures in the aged.Methods:The medical records of 80 aged patients with proximal humeral fractures were analyzed retrospectively.Forty patients were treated with locking compression plate internal fixation through shoulder lateral approach(group A),while the others were treated with locking compression plate internal fixation through ectopectoralis-deltoid approach(group B).The patients consisted of 49 males and 31 females and ranged in age from 62 to 74 years(Median=68 yrs)and in disease course from 3 to 19 hours(Median=11 hours).According to Neer classification standard of proximal humeral fracture,the fractures belonged to Neer 2-part(24),3-part(41)and 4-part(15)proximal humeral fractures.The incision length,intraoperative blood loss,operative time,Constant-Murley shoulder function scores and complications were compared between the 2 groups,and the total clinical curative effects were evaluated by using the Neer shoulder scoring standards.Results:The incision length and operative time were shorter,and the intraoperative blood loss were less in group A compared to group B(6.94+-1.28 vs 13.94+-2.67 cm,t=14.952,P=0.000; 66.73+-17.45 vs 91.14+-20.62 min,t=5.715,P=0.000; 124.54+-50.37 vs 303.41+-66.21 mL,t=13.598,P=0.000).There was no statistical difference in Constant-Murley shoulder function scores between the 2 groups before the surgery(t=0.286,P=0.776).The Constant-Murley shoulder function scores increased in the 2 groups at 3 months after the surgery compared to pre-surgery(40.64+-5.38 vs 82.66+-6.45 points,t=31.641,P=0.000; 40.98+-5.26 vs 75.52+-5.67 points,t=28.245,P=0.000),and were higher in in group A compared to group B(t=5.258,P=0.000).The total clinical curative effects were evaluated at 6 months after the surgery,28 patients obtained an excellent result,9 good and 3 fair in group A; while 19 patients obtained an excellent result,8 good,10 fair and 3 poor in group B.The group A surpassed the group B in the total clinical curative effects(Z=-2.511,P=0.012).The incision infection was found in 1 patient in group A and 5 patients in group B,and aseptic necrosis of head of humerus(3)and screw loosening(1)was found in group B.The postoperative complication incidence rate was lower in group A compared to group B(χ2=7.314,P=0.007).Conclusion:Locking compression plate internal fixation through shoulder lateral approach has the advantages of shorter incision length and operative time,less intraoperative blood loss,better shoulder function and total clinical curative effects and higher safety compared to locking compression plate internal fixation through ectopectoralis-deltoid approach in treatment of proximal humeral fractures in the aged.

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(收稿日期:2020-03-20本文編輯:郭毅曼)
更新日期/Last Update: 2020-10-10