【摘要】 目的比较经肩关节前外侧小切口与经三角肌胸大肌间隙切口复位、LPHP固定治疗移位的肱骨近端骨折的手术疗效。方法自2011-01—2013-08采用切开复位,LPHP固定治疗62例移位的肱骨近端骨折,52例获得随访,其中Neer 2部分骨折19例,3部分骨折22例,4部分11例。按照采用的手术入路分成小切口组(A组)和常规切口组(B组),A组经肩关节前外侧小切口,劈开三角肌,复位骨折,肌下置入LPHP钢板并固定近端,钢板远段另作小切口固定;B组采用三角肌胸大肌间隙切口入路,复位骨折,并采用LPHP固定。结果 52例获12~24个月的随访,平均16个月。平均手术时间:A组100 min,B组109 min。解剖复位:A组20例,B组21例;功能复位:A组3例,B组8例。平均骨折愈合时间:A组14.2周,B组15.7周。平均Constant评分,A组80.3分,B组76.6分。2组的手术时间、骨折愈合时间、肩关节功能比较,差异无统计学意义(P>0.05)。结论经肩前外侧小切口入路可达到与经三角肌胸大肌入路同样的复位效果,而且具有直观、创伤小的优点。更多还原

【Abstract】 Objective To compare the clinical outcomes of the treatment of the displaced proximal humeral fracture with a locking proximal humeral plate(LPHP) through a small incision on the anterolateral shoulder or a standard deltopectoral approach. Methods From January 2011 to August 2013, 62 cases of displaced proximal humeral fractures were surgically reduced and fixed with LPHP, of which the data of 52 cases were available for analysis. According to Neer’s classification,there were 19 patients with two-part fractures, 22 with 3-part and 11 with 4-part fractures. The patients were divided into two groups, according to the approaches, a small incision group(group A) and a deltopectoral incision group(group B). A small incision was made on the anterolateral shoulder in group A, the LPHP was inserted beneath the muscle and the proximal was fixed, the distal plate was fixed through another small incision. A deltopectoral approach was made in group B. The fracture was reduced and fixed with LPHP. Results A follow-up of mean 16 months, ranging from 12 to 24 months, was performed in52 cases. The mean operation time was 100 mins in group A, 109 mins in group B. There were 20 cases of anatomic reduction in group A, 21 cases in group B and 3 cases of functional reduction in group A, 8 cases in group B. The mean healing time was 14.2 weeks in group A, 15.7 weeks in group B. The mean Constant score was 80.3 in group A, 76.6 in group B. There were no statistically significant difference in operation time, healing time and the joint function(P >0.05). Conclusion Same satisfied clinical result could be obtained when the displaced proximal humeral fractures were treated by reduction and internal fixation with LPHP through a small anterolateral shoulder incision. Besides, this approach also has the advantages of easy exposure of the fracture and less soft tissue dissection.更多还原