Song Zheng-Xin, Liu Yan, Mao Ying-Fu, Li Bing-Yan, Wei Li-Jin, Tian Yun
Department of Orthopaedics, Beijing Jing Mei Group General Hospital, Beijing 102300, China;
Zhongguo Gu Shang. 2017 Mar 25;30(3):227-232. doi: 10.3969/j.issn.1003-0034.2017.03.008.
To explore the clinical curative effect of anterolateral acromial approach in treating two-and three-part of proximal humeral fractures.
Forty-two patients of proximal humeral fractures from January 2010 to June 2014 were analyzed retrospectively, including 23 males and 19 females with a mean age of 61.5 years old ranging from 40 to 76 years old. Among them, 22 cases were treated with anterolateral acromial approach and 20 cases were treated with deltopectoral approach. The operation time, intraoperative blood loss, postoperative hospitalization days, fracture healing time of two groups were compared. The shoulder pain after 1 week was assessed by the VAS score. The postoperative shoulder joint function was evaluated after 3 months and more than 6 months by Constant score.
The follow-up time was at final 14 months. There were significant differences in operation time(=0.003), intraoperative blood loss(=0.001), postoperative hospital day(=0.013), postoperative shoulder pain after 1 week(=0.026), postoperative Constant score after 3 months(=0.014) between the anterolateral acromial approach group and the deltopectoral approach group. There were no significant differences in clinical union time of bone(=0.462), postoperative constant score after more than 6 months(=0.204) between the anterolateral acromial approach group and the deltopectoral approach group. There were no breakage of the internal fixation and humeral head osteonecrosis.
It has some advantages with anterolateral acromial approach to treat Neer two-and three-part of proximal humeral fractures, such as short operation time, less intraoperative bleeding, lighter postoperative pain, quicker recovery of function.
探讨肩峰前外侧入路治疗肱骨近端二、三部分骨折的临床疗效。
回顾性分析2010年1月至2014年6月收治的42例肱骨近端骨折患者，其中男性23例，女性19例，平均年龄61.5岁，年龄范围40～76岁。其中22例采用肩峰前外侧入路治疗，20例采用三角肌胸大肌入路治疗。比较两组的手术时间、术中出血量、术后住院天数、骨折愈合时间。术后1周采用视觉模拟评分法（VAS）评估肩部疼痛情况。术后3个月及6个月以上采用Constant评分法评估肩关节功能。
随访时间最终为14个月。肩峰前外侧入路组与三角肌胸大肌入路组在手术时间（P = 0.003）、术中出血量（P = 0.001）、术后住院天数（P = 0.013）、术后1周肩部疼痛（P = 0.026）、术后3个月Constant评分（P = 0.014）方面差异有统计学意义。肩峰前外侧入路组与三角肌胸大肌入路组在骨临床愈合时间（P = 0.462）、术后6个月以上Constant评分（P = 0.204）方面差异无统计学意义。内固定无断裂及肱骨头坏死情况。
肩峰前外侧入路治疗Neer分型的肱骨近端二、三部分骨折具有手术时间短、术中出血少、术后疼痛轻、功能恢复快等优点。
