CAJ | 학술논문

背景：经典的三角肌胸大肌间沟入路软组织损伤较大，钢板放置于外侧困难，多放置于肱骨前外侧，固定位置不是最理想。 　　目的：探讨经肩外侧三角肌劈开入路治疗肱骨近端骨折的安全可行性。 　　方法：选取2008年8月至2013年8月期间，昆明医科大学附属延安医院骨科收治的肱骨外科颈骨折患者114例，均应用锁定加压钢板内固定治疗，按不同入路分为肩外侧三角肌劈开入路组和三角肌胸大肌间沟入路组各57例，比较两组手术创伤、骨折愈合、疗效及功能恢复(肩关节Constant评分)情况。 　　结果与结论：所有患者完成至少8个月的随访。与三角肌胸大肌间沟入路组比较，经肩外侧三角肌劈开入路治疗肱骨近端骨折，术后骨折均能如期愈合，肩关节的前屈、外展、抬肩活动以及上臂外侧皮肤的感觉功能均没有受影响，肩关节Constant评分两组比较差异无显著性意义(P >0.05)，表明经肩外侧三角肌劈开入路治疗肱骨近端骨折是可行又安全的。另外，依据Neer肩关节评分系统评估疗效，肩外侧三角肌劈开入路组优良率达91%，明显高于三角肌胸大肌间沟入路组的75%(P <0.05)。因此可以将肩外侧三角肌劈开入路作为治疗肱骨近端骨折的首选手术入路。
배경：경전적삼각기흉대기간구입로연조직손상교대，강판방치우외측곤난，다방치우굉골전외측，고정위치불시최이상。 　　목적：탐토경견외측삼각기벽개입로치료굉골근단골절적안전가행성。 　　방법：선취2008년8월지2013년8월기간，곤명의과대학부속연안의원골과수치적굉골외과경골절환자114례，균응용쇄정가압강판내고정치료，안불동입로분위견외측삼각기벽개입로조화삼각기흉대기간구입로조각57례，비교량조수술창상、골절유합、료효급공능회복(견관절Constant평분)정황。 　　결과여결론：소유환자완성지소8개월적수방。여삼각기흉대기간구입로조비교，경견외측삼각기벽개입로치료굉골근단골절，술후골절균능여기유합，견관절적전굴、외전、태견활동이급상비외측피부적감각공능균몰유수영향，견관절Constant평분량조비교차이무현저성의의(P >0.05)，표명경견외측삼각기벽개입로치료굉골근단골절시가행우안전적。령외，의거Neer견관절평분계통평고료효，견외측삼각기벽개입로조우량솔체91%，명현고우삼각기흉대기간구입로조적75%(P <0.05)。인차가이장견외측삼각기벽개입로작위치료굉골근단골절적수선수술입로。
BACKGROUND:Classical deltopectoral approach leads to a great injury to soft tissues. It is difficult to lay the steel plate on the lateral side. The steel plate is frequently laid on the anterolateral side of humerus. Fixed position is not ideal. OBJECTIVE:To evaluate the safety and feasibility of lateral deltoid-splitting approach in treatment of proximal humeral fractures. METHODS:From August 2008 to August 2013, 114 patients with fracture of surgical neck of humerus, who were treated in the Department of Orthopedics, Yan’an Hospital Affiliated to Kunming Medical University in China, were enrol ed in this study. They were treated with locking compression plate, and assigned to deltoid splitting approach group and deltopectoral approach group (n=57). Surgical trauma, fracture healing, curative effects, functional recovery and Constant shoulder score were compared between the two groups. RESULTS AND CONCLUSION:Al patients were fol owed up for at least 8 months. Compared with the deltopectoral approach group, the proximal humeral fractures were healed as scheduled in the deltoid splitting approach group, and the anteflexion, abduction, shoulder lifting of the shoulder joint, and sensation of lateral skin of the upper arm were not impacted. No significant difference in Constant shoulder score was detectable between the two groups (P>0.05), which suggested that deltoid splitting approach for treating the proximal humeral fractures was safe and feasible. In addition, in accordance with the Neer’s classification system, the excellent and good rate in the deltoid splitting approach group (91%) was significantly higher than that in the deltopectoral approach group (75%) (P<0.05). Therefore, the deltoid splitting approach can be used as the first choice for the treatment of proximal humeral fractures.