肱骨近端外展嵌插型骨折两种入路复位内固定比较

Lateral deltoid-splitting approach versus deltopectoral approach for open reduction and internal fixation of proximal hu⁃ meral abduction impacted fractures

摘要:

［目的］比较经三角肌入路与胸大肌-三角肌入路开放复位锁钉接骨板内固定外展嵌插型肱骨近端骨折的临床疗效。 ［方法］ 回顾性分析 2017 年 1 月—2019 年 12 月采用开放复位内固定治疗外展嵌插型肱骨近端骨折 61 例患者的临床资料。依据术前医患沟通结果，34 例采用三角肌劈开入路（三角肌组），27 例采用胸大肌-三角肌间隙入路（肌间隙组）。比较分析两组围手术期、随访及影像学资料。［结果］两组患者均顺利完成手术，无严重并发生。三角肌组手术时间、术中出血量、切口总长度均显著优于肌间隙组，差异均有统计学意义 （P<0.05）；两组在术中透视次数、术后主动患肢活动时间、伤口愈合和住院时间等方面差异均无统计学意义（P>0.05）。三角肌组恢复完全负重活动显著早于肌间隙组（P<0.05）。随术后时间推移，两组患者的 VAS 评分显著减少（P<0.05），而肩上举-后伸 ROM 和 Constant-Murley 评分均显著增加（P<0.05）。术后 1、3 个月三角肌组的 VAS 评分、肩上举-后伸 ROM 和 Constant-Murley 评分均显著优于肌间隙组 （P<0.05），但术后 1 年两组间的 VAS 评分、肩上举-后伸 ROM 和 Constant-Murley 评分差异无统计学意义 （P>0.05）。影像方面，骨折复位优良率三角肌组为 94.12％，肌间隙组为 96.30％，差异无统计学意义 （P>0.05）。两组患者骨折均愈合，骨折愈合时间差异无统计学意义 （P> 0.05）。［结论］ 与胸大肌-三角肌间隙入路相比，经三角肌入路治疗外展嵌插型肱骨近端骨折具有软组织损伤小、并发症少、 能提前恢复功能等优点。

Abstract:

[Objective] To compare the clinical efficacy of the lateral deltoid-splitting approach (LDSA) versus deltopectoral approach (DPA) for open reduction and internal fixation (ORIF) of proximal humeral abduction impacted fractures. [Methods] A retrospective study was conducted on 61 patients who underwent ORIF for proximal humeral abduction impacted fractures in our hospital from January 2017 to December 2019. Based on the consequence of perioperative patient-surgeon communication, 34 patients had ORIF performed through the LDSA, while the remaining 27 patients were through the DPA. The perioperative, follow-up and imaging data were analyzed and compared between the two groups. [Results] The patients in both groups had surgical procedures conducted smoothly without serious complications. The LDSA group proved significantly superior to the DPA group in terms of operation time, intraoperative blood loss, total incision length (P＜0.05) , whereas no significant differences were noted between the two groups in intraoperative fluoroscopic frequency, the time to re- sume active motion of the affected limb, incision healing and hospital stay (P＞0.05) . The LDSA group resumed full-weight bearing activity of the involved extremity significantly earlier than the DPA group (P＜0.05) . The VAS score significantly decreased, whereas the forward flexion-backward extension range of motion (ROM) of the shoulder and Constant-Murley score significantly increased over time postopera- tively in both groups (P＜0.05) . The LDSA group proved significantly superior to the DPA group in abovementioned items postoperatively at 1 months and 3 months after operation(P＜0.05) , but there was no significant difference in VAS score, forward flexion-backward extension range of motion (ROM) of the shoulder and Constant-Murley score between the two groups one year after operation (P＞0.05) . With respect to radiographic assessment, the excellent and good rate of fracture reduction quality was 94.12% in the LDSA group, whereas 96.30% in DPA group，which was not statistically significant (P＞0.05) . Bony fracture healing achieved in all patients of both groups with no a statisti- cally significant difference in fracture healing time between the two groups (P＞0.05) . [Conclusion] The LDSA has advantages of less soft tissue damage, fewer complications and earlier functional recovery over the DPA for ORIF of proximal humeral abduction impacted frac- tures