| 肩峰前外侧入路与胸大肌三角肌入路治疗肱骨近端Neer 2、3部分骨折的病例对照研究 |
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投稿时间：2014-08-26
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| 作者 | Author | 单位 | Address | E-Mail |
| 陈启明 |
CHEN Qi-ming |
浙江上虞人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, People's Hospital of Shangyu, Shangyu 312300, Zhejiang, China |
cqm211@126.com |
| 季烈峰 |
JI Lie-feng |
浙江上虞人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, People's Hospital of Shangyu, Shangyu 312300, Zhejiang, China |
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| 潘志军 |
PAN Zhi-jun |
浙江大学医学院附属第二医院骨科, 浙江 杭州 310009 |
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| 周晓俊 |
ZHOU Xiao-jun |
浙江上虞人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, People's Hospital of Shangyu, Shangyu 312300, Zhejiang, China |
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| 朱江 |
ZHU Jiang |
浙江上虞人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, People's Hospital of Shangyu, Shangyu 312300, Zhejiang, China |
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| 曹浙标 |
CAO Zhe-biao |
浙江上虞人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, People's Hospital of Shangyu, Shangyu 312300, Zhejiang, China |
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| 徐丁 |
XU Ding |
浙江上虞人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, People's Hospital of Shangyu, Shangyu 312300, Zhejiang, China |
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| 陈巨坤 |
CHEN Ju-kun |
浙江上虞人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, People's Hospital of Shangyu, Shangyu 312300, Zhejiang, China |
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| 期刊信息：《中国骨伤》2014年，第27卷，第12期，第991-994页 |
| DOI：10.3969/j.issn.1003-0034.2014.12.004 |
| 基金项目: |
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中文摘要:
目的: 对比肩峰前外侧入路与胸大肌三角肌入路在肱骨近端Neer 2、3部分骨折手术治疗中的临床疗效.
方法: 回顾性分析2009年1月至2012年12月收治并获随访的49例肱骨近端Neer 2、3部分骨折患者的资料,其中肩峰前外侧入路组22例,男9例,女13例,平均年龄(63.2±7.6)岁;胸大肌三角肌入路组27例,男12例,女15例,平均年龄(62.9±7.0)岁.比较两组患者的手术时间、术中出血量与骨折愈合时间及术后并发症,术后3个月及1、2年时分别采用Constant-Murley评分和视觉模拟评分法(VAS)评定肩关节功能及患肩疼痛度.
结果: 所有患者术后获随访,时间24～41个月,平均34.5个月.肩峰前外侧入路组手术时间[(68.20±7.04) min]较胸大肌三角肌入路组[(75.81±13.70) min]短,术中出血量[(151.30±20.57) ml]少于胸大肌三角肌入路组[(242.10±37.25) ml],骨折愈合时间[(10.88±4.90)周]短于胸大肌三角肌入路组[(13.60±2.45)周].术后3个月,肩峰前外侧入路组Constant-Murley评分88.32±5.45,肩关节疼痛VAS评分0.41±0.63,均优于胸大肌三角肌入路组[(63.53±8.31)vs(1.65±1.02)].但术后1年及2年,两组Constant-Murley评分与肩关节疼痛VAS评分差异均无统计学意义.两组各有1例术后出现肱骨头高度丢失,胸大肌三角肌入路组另有1例肩峰下撞击、1例螺钉松动及2例骨折延迟愈合.两组均未发生腋神经损伤及肱骨头坏死和内固定断裂等并发症.
结论: 采用肩峰前外侧入路与胸大肌三角肌入路手术治疗肱骨近端Neer 2、3部分骨折最终均可获得满意的中期疗效,前者更具有创伤小、出血少、手术时间短、术后肩关节功能恢复及骨折愈合快等优点. |
| 【关键词】肱骨骨折,近端 骨折固定术,内 病例对照研究 |
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| Treating Neer two-and three-part of proximal humeral fractures through anterolateral acromial approach and deltopectoral approach |
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ABSTRACT
Objective: To compare clinical results of treating Neer two-and three-part of proximal humeral fractures between anterolateral acromial approach and deltopectoral approach.
Methods: 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.
Results: 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.
Conclusion: 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. |
| KEY WORDS Humeral fractures,proximal Fracture fixation,internal Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈启明,季烈峰,潘志军,周晓俊,朱江,曹浙标,徐丁,陈巨坤.肩峰前外侧入路与胸大肌三角肌入路治疗肱骨近端Neer 2、3部分骨折的病例对照研究[J].中国骨伤,2014,27(12):991~994 |
| 英文格式: | CHEN Qi-ming,JI Lie-feng,PAN Zhi-jun,ZHOU Xiao-jun,ZHU Jiang,CAO Zhe-biao,XU Ding,CHEN Ju-kun.Treating Neer two-and three-part of proximal humeral fractures through anterolateral acromial approach and deltopectoral approach[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(12):991~994 |
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