扩展劈三角肌入路与胸三角肌入路治疗肱骨近端骨折的临床疗效比较

发布时间：2018-05-28 03:44

本文选题：肱骨近端骨折 + 扩展劈三角肌入路　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：比较扩展劈三角肌入路、胸三角肌入路两种不同手术入路治疗肱骨近端骨折的临床疗效的差异，为不同肱骨近端骨折切开复位钢板内固定入路选择提供依据。方法：对2012年8月至2014年8月在吉林大学第一医院创伤骨科收治的肱骨近端骨折患者，符合应用钢板内固定，且分别行胸三角肌入路和扩展劈三角肌入路的患者为33例，摔伤为27例，车祸为5例，电击伤1例。其中应用扩展劈三角肌入路13为A组，应用胸三角肌入路20例为B组。对所有患者进行病例记录查询、门诊以及电话随访，随访时间12～24个月，平均16.4个月。对两组患者的手术时间、手术切口、围手术期失血量、住院时间、愈合时间、Constant-Murley评分等指标进行分析。应用SPSS17.0软件对数据进行统计分析。结果： A组，，手术时间：79.54±7.30min，手术切口：10.00±2.16cm，围手术期失血：100.38±16.64ml，住院时间：8.38±3.01d，愈合时间：102.07±14.07d,Constant-Murley评分(3个月，12个月)：71.38±5.30分，83.08±5.88分。B组，手术时间：88.05±8.04min，手术切口：13.45±2.26cm，围手术期失血量119.00±24.63ml，住院时间：8.90±3.61d，愈合时间：96.40±19.69d,Constant-Murley评分(3个月，12个月)：64.55±5.12分，79.15±7.19分。术后伤口均一期愈合，骨折均骨性愈合，未发生切口感染、螺钉松动、螺钉切割、肱骨头坏死等并发症。比较两组患者住院时间、愈合时间、术后12个月Constant-Murley评分，扩展劈三角肌入路优于传统入路，但无明显统计学差异。两组患者在手术时间、手术切口、围手术期出血量、术后3个月Constant-Murley评分上扩展劈三角肌入路优于胸三角肌入路，且两组比较差异有统计学意义（P＜0.05）。结论： 1、扩展劈三角肌入路具有软组织损伤少，暴露好，肩关节功能恢复快，适用于老年低能量损伤所致肱骨近端骨折。 2、对于高能量损伤所致的，三角肌发达的年轻患者，胸三角肌入路相对安全，利于复位。
[Abstract]:Objective: To compare the clinical effects of two different surgical approaches for proximal humerus fracture with extended cleavage deltoid approach and thoracic deltoid approach and to provide evidence for the choice of open reduction and internal fixation for different proximal humerus fractures. Methods: From August 2012 to August 2014, 33 patients with proximal humerus fracture treated in Department of Orthopedics of the first Hospital of Jilin University were treated with internal fixation with plate, 33 patients were treated with thoracic deltoid muscle approach and 27 patients were injured by the extended cleavage deltoid approach. There were 5 cases of traffic accident and 1 case of electric injury. Group A was treated with extended cleavage deltoid approach and group B with thoracic deltoid approach. All patients were followed up for 12 ~ 24 months (mean 16.4 months). The operative time, incision, perioperative blood loss, hospitalization time, healing time and Constant-Murley score were analyzed. The data were analyzed by SPSS17.0 software. Results: In group A, the operative time was: 79.54 卤7.30 min, the operative incision was 10. 00 卤2. 16 cm, the perioperative blood loss was 10 0.38 卤16. 64 ml, the hospitalization time was 8. 38 卤3. 01 days, the healing time was 10. 102. 07 卤14. 07 days and Constant-Murley score (3 months, 12 months: 71. 38 卤5. 30 卤83. 08 卤5. 88, group B). The operative time was 88.05 卤8.04 min, the operative incision was 13. 45 卤2. 26 cm, the blood loss was 119.00 卤24. 63 ml, the hospitalization time was 8. 90 卤3. 61 days, the healing time was 9. 96. 40 卤19. 69 days and Constant-Murley score (3 months, 12 months): 64.55 卤5. 12 minutes 79.15 卤7. 19 points. All the wounds healed at the first stage, and the fractures healed with no wound infection, screw loosening, screw cutting, necrosis of the humeral head and so on. The hospitalization time, healing time, Constant-Murley score at 12 months after operation, extended cleavage deltoid approach were better than the traditional approach, but there was no significant difference between the two groups. The operative time, incision, perioperative bleeding and Constant-Murley score of the two groups were better than that of the thoracic deltoid approach (P < 0.05). Conclusion: 1. The extended cleavage deltoid approach has the advantages of less soft tissue injury, better exposure and faster recovery of shoulder joint function, which is suitable for the fracture of proximal humerus caused by low energy injury in the elderly. 2. For the young patients with high energy injury and developed deltoid muscle, the thoracic deltoid approach is relatively safe and conducive to reduction.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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