【摘要】 目的探讨三角肌入路与肩峰下入路锁定钢板内固定治疗老年肱骨近端骨折近期疗效及对凝血功能的影响。方法 2015年1月—2018年1月笔者医院收治肱骨近端骨折患者80例,根据手术入路的不同将患者分为三角肌入路组和肩峰下入路组各40例。三角肌入路组患者采用三角肌入路锁定钢板内固定治疗,肩峰下入路组患者采用肩峰下入路锁定钢板内固定治疗。比较两组患者近期疗效、并发症及凝血功能指标变化情况。结果肩峰下入路组患者手术时间、住院时间、骨折愈合时间及术中出血量显著少于三角肌入路组[(65.80±11.51)min vs.(87.41±10.22)min、(7.23±2.10)d vs.(9.71±3.21)d、(68.49±6.60)d vs.(94.39±8.79)d、(89.63±6.92)mL vs.(93.17±7.19)mL,P<0.05]。治疗后两组患者Neer评分均显著高于治疗前,其中肩峰下入路组Neer评分上升幅度显著高于三角肌入路组[(93.17±7.94)分vs.(77.56±10.51)分],P<0.05;治疗后,两组患者国际标准化比值(INR)指标水平均无明显变化(P>0.05),血浆凝血酶原时间(PT)、活化部分凝血酶时间(APTT)指标水平均较治疗前显著降低(P<0.05);三角肌入路组患者治疗后血浆纤维蛋白原(FIB)指标水平明显高于肩峰下入路组(P<0.05);肩峰下入路组患者术后并发症总发生率为2.50%,显著低于三角肌入路组(15.00%,χ~2=3.914,P=0.048)。结论肩峰下入路锁定钢板内固定治疗老年肱骨近端骨折近期疗效显著,可显著改善老年患者肩关节功能及凝血功能指标水平,安全性高,值得临床推广。更多还原

【Abstract】 Objective To compare the short-term efficacy and the coagulation function of locking plate internal fixation in the treatment of proximal humeral fractures in elderly patients via subacromial approach versus deltoid approach. Methods From Jan. 2015 to Jan. 2018,80 patients with proximal humeral fracture admitted to Shanghai Punan Hospital of Pudong New Area were divided into the deltoid approach group and the subacromial approach group according to different surgical methods,with 40 cases in each group. Patients in the deltoid approach group were treated with locking plate internal fixation through the deltoid approach,while patients in the subacromial approach group were treated with locking plate internal fixation through the subacromial approach. The short-term efficacy,complications and coagulation function of the two groups were compared. Results The operative time,hospitalization time,fracture healing time and intraoperative blood loss of patients in the subaromial approach group were significantly less than those in the deltoid approach group(P<0.05). After treatment,Neer scores of patients in both groups were significantly higher than those before treatment,and the increase of Neer scores in the subacromial approach group was significantly higher than that in the deltoid approach group(P<0.05). After treatment,there was no significant change in the levels of INR indicators in the two groups(P>0.05),and the levels of PT and APTT indicators were significantly reduced compared with those before treatment(P<0.05). After treatment,the FIB level of patients in the deltoid approach group was significantly higher than that in the subacromial approach group(P<0.05). The total incidence of postoperative complications in the subacromial approach group was 2.50%,significantly lower than that in the deltoid approach group(15.00%,χ~2=3.914,P=0.048). Conclusion Locking plate internal fixation through the subacromial approach has significant short-term efficacy in the treatment of elderly proximal humeral fractures,which can significantly improve the level of shoulder joint function and coagulation function indicators in elderly patients,has high safety and is worthy of clinical promotion.更多还原