经扩展劈三角肌与经胸三角肌入路治疗肱骨近端骨折的临床观察

摘要

Objective To observe the clinical effect of extended deltoid approach and transthoracic deltoid approach in the treatment of proximal humeral fracture. Methods 76 cases of proximal humeral fracture in our hospital from September 2015 to February 2017 were divided into observation group (extended deltoid approach) and control group (transthoracic deltoid approach) according to the operative approaches, 38 cases in each group. The clinical effects of the two groups were compared. Results The operation time [(80.42±5.82) min], wound healing time [(94.02±14.47)d] of the observation group were shorter than those of the control group [(86.72±6.57) min, (112.48±14.50)d], the volume of intraoperative bleeding [(96.83±11.82)ml] and postoperative drainage [(86.67±9.10)ml] were less than those of the control group [(121.00±15.21)ml, (103.32±10.14)ml], with statistically significant differences (P<0.05). 3 months after surgery, Constant-Murley score in the two groups were significantly higher than those at the end of surgery, and Constant-Murley score in the observation group [(72.86±4.06)] was higher than that in the control group [(64.72±4.86)], with statistically significant difference (P<0.05). There were no vascular injury, incision infection, screw loosening or other postoperative complications in the two groups. Conclusion The extended deltoid approach is more effective in the treatment of proximal humeral fracture compared with transthoracic deltoid approach, which can reduce the operation time and the volume of intraoperative bleeding, and promote the recovery of the patients.%目的 观察经扩展劈三角肌与经胸三角肌入路治疗肱骨近端骨折的临床效果.方法 选取2015年9月至2017年2月于本院治疗的肱骨近端骨折患者76例,根据入路方式不同将其分为观察组(经扩展劈三角肌入路治疗)和对照组(经胸三角肌入路治疗),各38例.对比两组患者的临床效果.结果 观察组患者手术时间[(80.42±5.82)min比(86.72±6.57)min]、切口愈合时间[(94.02±14.47)d比(112.48±14.50)d]短于对照组,术中出血量[(96.83±11.82)ml比(121.00±15.21)ml]、术后引流量[(86.67±9.10)ml比(103.32±10.14)ml]少于对照组,差异有统计学意义(P<0.05);术后3个月,两组患者Constant-Murley评分显著高于术后,且观察组高于对照组[(72.86±4.06)比(64.72±4.86)],差异有统计学意义(P<0.05);两组患者术后均未出现血管损伤、切口感染、螺钉松动等并发症.结论经扩展劈三角肌入路治疗在肱骨近端骨折患者中的治疗效果较经胸三角肌手术入路显著,可减少患者的手术时间及术中出血量,促进患者恢复.