李月明

[摘要] 目的 探究肱骨近端骨折采取經(jīng)肩峰下前外側(cè)入路微創(chuàng)內(nèi)固定的治療效果。方法 以隨機(jī)法對(duì)2018年1月—2019年10月期間收治的52例肱骨近端骨折患者分成參照組(n=26)與試驗(yàn)組(n=26),參照組實(shí)施胸大肌三角肌間隙入路微創(chuàng)內(nèi)固定治療,試驗(yàn)組實(shí)施經(jīng)肩峰下前外側(cè)入路微創(chuàng)內(nèi)固定治療,對(duì)比兩組患者術(shù)中出血量、手術(shù)操作時(shí)間、愈合時(shí)間、住院時(shí)間及并發(fā)癥發(fā)生情況。結(jié)果 試驗(yàn)組患者術(shù)中出血量、手術(shù)操作時(shí)間、愈合時(shí)間、住院時(shí)間分別為(82.72±6.57)mL、(72.86±3.69)min、(3.16±0.12)月、(12.05±2.37)d均少于參照組的(106.81±8.92)mL、(96.37±4.38)min、(4.08±0.19)月、(20.94±3.29)d,差異有統(tǒng)計(jì)學(xué)意義(t=11.088、20.931、20.875、11.180,P<0.05),試驗(yàn)組患者并發(fā)癥發(fā)生率為3.85%低于參照組的30.77%,差異有統(tǒng)計(jì)學(xué)意義(χ2=4.837,P<0.05)。結(jié)論 肱骨近端骨折采取經(jīng)肩峰下前外側(cè)入路微創(chuàng)內(nèi)固定的治療效果顯著,能減少術(shù)中出血量,縮短住院及愈合時(shí)間,安全性較高。
[關(guān)鍵詞] 內(nèi)固定;微創(chuàng);肱骨近端骨折;肩峰下前外側(cè)入路
[中圖分類號(hào)] R5 ? ? ? ? ?[文獻(xiàn)標(biāo)識(shí)碼] A ? ? ? ? ?[文章編號(hào)] 1674-0742(2020)11(a)-0016-03
Analysis of Clinical Efficacy of Minimally Invasive Internal Fixation via Subacromial Anterolateral Approach in the Treatment of Proximal Humeral Fractures
LI Yue-ming
Department of Orthopedics, Shanting District People's Hospital, Zaozhuang, Shandong Province, 277200 China
[Abstract] Objective To explore the effect of minimally invasive internal fixation for proximal humeral fractures through the subacromial anterolateral approach. Methods The 52 patients with proximal humeral fractures admitted from January 2018 to October 2019 were divided into a reference group (n=26) and a test group (n=26) by randomization. The reference group received the pectoralis major deltoid muscle Interstitial approach minimally invasive internal fixation, the experimental group received minimally invasive internal fixation through the subacromial anterolateral approach, and compared the two groups of patients' intraoperative blood loss, operation time, healing time, hospital stay and complications. Results The amount of blood loss, operation time, healing time, and hospitalization time of the test group were (82.72±6.57)mL,(72.86±3.69)min,(3.16±0.12)months,(12.05±2.37)d shorter than those of the reference group(106.81±8.92)mL,(96.37±4.38)min,(4.08±0.19)months,(20.94±3.29)d,the difference was statistically significant(t=11.088,20.931,20.875,11.180,P<0.05), the complication rate of the experimental group was 3.85% lower than that of the reference group 30.77%,the difference was statistically significant(χ2=4.837,P<0.05). Conclusion The treatment of proximal humeral fractures with minimally invasive internal fixation through the subacromial anterolateral approach can reduce intraoperative blood loss, shorten hospitalization and healing time, and is safer.
[Key words] Internal fixation; Minimally invasive; Proximal humeral fracture; Subacromial anterolateral approach
[2] ?單輝強(qiáng),李翀,鄔亞明, 等.肩峰下外側(cè)經(jīng)三角肌入路微創(chuàng)經(jīng)皮接骨板內(nèi)固定技術(shù)結(jié)合PHILOS接骨板治療肱骨近端骨折[J].中華骨與關(guān)節(jié)外科雜志,2016,9(5):418-420.
[3] ?楊小海,徐鋒,錢平康, 等.肩峰下微創(chuàng)入路治療肱骨近端二部分、三部分骨折[J].中國(guó)血液流變學(xué)雜志,2017,27(1):72-73,104.
[4] ?張笑,張鵬舉,謝冰, 等.肩峰下橫切口微創(chuàng)接骨板內(nèi)固定治療肱骨近端骨折的臨床分析及手術(shù)技巧[J].中華骨與關(guān)節(jié)外科雜志,2016,9(1):49-52.
[5] ?鄧鋒,郭英,王濤, 等.經(jīng)皮微創(chuàng)鋼板內(nèi)固定術(shù)治療肱骨近端骨折的療效觀察[J].科學(xué)養(yǎng)生,2019,22(10):257.
[6] ?葉斌,王吟,葉正時(shí).肱骨近端骨折運(yùn)用微創(chuàng)鋼板內(nèi)固定結(jié)合肱骨近端鎖定鋼板治療的觀察[J].當(dāng)代醫(yī)學(xué),2019,25(21):105-107.
[7] ?鐘洪波.經(jīng)皮微創(chuàng)鋼板內(nèi)固定術(shù)治療肱骨近端骨折的療效觀察[J].特別健康,2019(18):247.
[8] ?謝明銳,唐詩(shī)添.微創(chuàng)鎖定鋼板內(nèi)固定術(shù)治療老年肱骨近端骨折患者的臨床療效分析[J].四川醫(yī)學(xué),2019,40(8):834-837.
[9] ?王旭東.比較研究微創(chuàng)肱骨近端鎖定鋼板、傳統(tǒng)固定術(shù)治療肱骨近端骨折的實(shí)際價(jià)值[J].養(yǎng)生保健指南,2019,(47):247.
[10] ?Qing-Feng Shen, Xin Wen, Sheng-Wu Yang. MIPPO and ORIF for the treatment of elderly proximal humerus fractures of type Neer II:a case control study[J].China Journal of Orthopaedics & Traumatology, 2018, 31(2):160-164.
[11] ?Zadeh Hamid G, Somasundaram Karthikeyan, Babu Victor. Internal Fixation of 4-Part Proximal Humerus Fractures and Fracture Dislocations Using Extended Deltoid-splitting Approach, Locking Plates, and Calcium Sulfate Graft: Technical Details[J].Techniques in Shoulder & Elbow Surgery, 2018,19:129-137.
[12] ?馬永江,夏衛(wèi)革,曾永新, 等.經(jīng)肩峰下前外側(cè)入路微創(chuàng)內(nèi)固定治療肱骨近端骨折臨床療效觀察[J].實(shí)用手外科雜志,2019,33(3):266-268,278.
[13] ?Shan Huiqiang, Li Yi, Tong Yaming, et al. Treatment of proximal humerus fractures with minimally invasive percutaneous osteosynthesis plate fixation combined with PHILOS osteosynthesis plate through the deltoid muscle approach to the sub lateral acromion[J].Chinese Journal of Bone and Joint Surgery, 2016,9(5): 418-420.
(收稿日期:2020-08-05)