【摘要】 目的 分析肩峰下入路实施微创锁定钢板内固定术在肱骨近端骨折(PHFs)患者治疗中的应用价值。方法 选取本院骨外科2020年1月至2022年1月收治的94例PHFs患者为研究对象，随机数字表法分为研究组和对照组，各47例。两组均实施微创锁定钢板内固定术，研究组采用肩峰下入路，对照组采用三角肌胸大肌入路。比较两组手术指标、并发症发生情况、手术前后体液免疫功能[免疫球蛋白(IgA)、IgG、IgM]、疼痛程度(VAS评分)、肩关节功能(Neer评分)及肩关节活动范围。结果 研究组手术时间、住院时间、骨折愈合时间短于对照组，术中出血量少于对照组(P<0.05);研究组并发症总发生率(4.26%)与对照组(14.89%)比较，差异无统计学意义(P>0.05);术后1d、3d两组血清IgA、IgG、IgM水平较术前降低，且研究组高于对照组(P<0.05);术后6个月研究组Neer评分高于对照组，VAS评分低于对照组(P<0.05);术后6个月研究组肩关节外旋、内旋、上举活动范围大于对照组(P<0.05)。结论 肩峰下入路微创锁定钢板内固定术治疗PHFs安全性高，能优化手术路径，减少术中出血，减轻体液免疫功能损伤，促进骨折愈合，缓解患者疼痛，提高肩关节功能和活动范围。更多还原

【Abstract】 Objective To analyze the application value of minimally invasive locking plate internal fixation through subacromial approach in the treatment of patients with proximal humeral fractures(PHFs).Methods A total of 94 patients with PHFs who were admitted to the Department of Orthopedics in our hospital from January 2020 to January 2022 were selected as the research objects, and divided into the study group and the control group by random number table method, with 47 cases in each.Minimally invasive locking plate internal fixation was performed in both groups.The subacromial approach was used in the study group, and the deltoid pectoralis major approach was used in the control group.The surgical indicators, complications, humoral immune function[immunoglobulin(IgA),IgG,IgM],pain level(VAS score),shoulder joint function(Neer score)and shoulder range of motion before and after surgery were compared between the two groups.Results The operation time, hospital stay and fracture healing time of the study group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group(P<0.05).There was no significant difference(P>0.05);the levels of serum IgA,IgG,and IgM in the two groups were lower than those before surgery on 1 and 3 days after surgery, and the study group was higher than the control group(P<0.05);6 months after surgery, the study group The Neer score was higher than that of the control group, and the VAS score was lower than that of the control group(P<0.05).The range of motion of shoulder external rotation, internal rotation and lift of the shoulder joint in the study group was greater than that in the control group(P<0.05).Conclusion The subacromial approach minimally invasive locking plate internal fixation in the treatment of PHFs has high safety, can optimize the operative path, reduce intraoperative bleeding, reduce the damage of humoral immune function, promote fracture healing, relieve pain, and improve shoulder function and range of motion.更多还原