Chen Qi-ming, Ji Lie-feng, Pan Zhi-jun, Zhou Xiao-jun, Zhu Jiang, Cao Zhe-biao, Xu Ding, Chen Ju-kun
Zhongguo Gu Shang. 2014 Dec;27(12):991-4.
To compare clinical results of treating Neer two- and three-part of proximal humeral fractures between anterolateral acromial approach and deltopectoral approach.
From January 2009 to December 2012, 49 patients with Neer two- and three-part of proximal humeral fractures were treated with locked plate fixation. In anterolateral acromial approach group, there were 22 patients including 9 males and 13 females with an average of (63.2±7.6) years old, while 27 patients in deltopectoral approach including 12 males and 15 females with an average of (62.9±7.0) years old. Operative time, blood loss during operation, fracture healing time and complications were observed and compared, postoperative Constant-Murley scoring and VAS scoring were applied for evaluate function of shoulder joint and pain at 3 months, 1 and 2 years respectively.
All patients were followed up from 24 to 41 months with an average of 34.5 months. Operative time, blood loss, fracture healing time in anterolateral acromial approach group was (68.20±7.04) min, (151.30±20.57) ml, (10.88±4.90) weeks respectively, and better than that of in deltopectoral approach group which was (75.81±13.70) min, (242.10±37.25) ml and (13.60±2.45) weeks. Three months after operation, Constant-Murley scoring and VAS score in anterolateral acromial approach group was 88.32±5.45, 0.41±0.63 and better that of in deltopectoral approach group which was 63.53±8.31, 1.65±1.02. There was no significant differences between two groups in Constant-Murley scoring and VAS score at 1 and 2 years after operation. Each group has one case occurred loss of length humerus head height, and there was 1 case with subacromial impingement, 1 case with bolt loose and 2 cases with delayed union in deltopectoral approach. No axillary nerve injury, humeral head necrosis and breakage of internal fixation occurred both of two groups.
Both of anterolateral acromial approach and deltopectoral approach are effective in treating Neer two- and three-part of proximal humeral fractures, and can obtain excellent outcomes. Moreover, anterolateral acromial approach has advantage of less trauma, less blood loss, shorter operative time, rapid recovery of shoulder joint function and fracture.
比较经肩峰前外侧入路与经三角肌胸大肌间沟入路治疗NeerⅡ、Ⅲ型肱骨近端骨折的临床效果。
2009年1月至2012年12月，49例NeerⅡ、Ⅲ型肱骨近端骨折患者采用锁定钢板固定治疗。其中经肩峰前外侧入路组22例，男9例，女13例，平均年龄（63.2±7.6）岁；经三角肌胸大肌间沟入路组27例，男12例，女15例，平均年龄（62.9±7.0）岁。观察并比较两组手术时间、术中出血量、骨折愈合时间及并发症，分别于术后3个月、1年及2年采用Constant-Murley评分及视觉模拟评分法（VAS）评估肩关节功能及疼痛情况。
所有患者均获随访，随访时间24～41个月，平均34.5个月。经肩峰前外侧入路组手术时间、术中出血量、骨折愈合时间分别为（68.20±7.04）min、（151.30±20.57）ml、（10.88±4.90）周，均优于经三角肌胸大肌间沟入路组的（75.81±13.70）min、（242.10±37.25）ml、（13.60±2.45）周。术后3个月，经肩峰前外侧入路组Constant-Murley评分及VAS评分分别为88.32±5.45、0.41±0.63，优于经三角肌胸大肌间沟入路组的63.53±8.31、1.65±1.02。术后1年及2年，两组Constant-Murley评分及VAS评分差异无统计学意义。经三角肌胸大肌间沟入路组有1例出现肱骨头高度丢失，1例发生肩峰下撞击，1例出现螺钉松动，2例出现骨折延迟愈合。两组均未发生腋神经损伤、肱骨头坏死及内固定断裂。
经肩峰前外侧入路与经三角肌胸大肌间沟入路治疗NeerⅡ、Ⅲ型肱骨近端骨折均有效，均可获得良好疗效。且经肩峰前外侧入路具有创伤小、出血少、手术时间短、肩关节功能及骨折恢复快等优点。
