| 朱新红,黄飞,陶德刚,等.小切口经三角肌入路微创固定治疗肱骨近端骨折.骨科,2014,5(3): 154-157. |
| 小切口经三角肌入路微创固定治疗肱骨近端骨折 |
| Treatment of proximal humerus fractures through a small incision into the deltoid and minimally internal fixation |
| 投稿时间：2014-02-17 |
| DOI：10.3969/j.issn.1674-8573.2014.03.008 |
| 中文关键词: 肱骨 骨折 肩关节 内固定器 |
| 英文关键词: Humerus Fractures, bone Shoulder joint Internal fixators |
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| 中文摘要: |
| 目的 探讨小切口经三角肌入路微创复位固定治疗肱骨近端骨折的临床效果。方法 自2009年1月至2013年12月采用经肩关节前外侧三角肌入路治疗肱骨近端骨折48例。根据Neer分型：Ⅱ型20例，Ⅲ型24例，Ⅳ型4例。经肩前外侧三角肌自肩峰下1.5 cm纵向切开皮肤3.0～5.0 cm，沿肌纤维方向劈开三角肌，显露骨折，直视下直接或间接复位，在肌层表面向远端插入钢板，近远端分别置入锁钉螺钉固定。结果 本组手术时间30～60 min，平均40 min；术中出血30～100 mL，无需输血。术后住院时间3～7 d，切口均一期愈合，所有病例均获得随访，时间12～24个月。骨折全部愈合，按Neer功能评分：优42例，良4例，可2例。无一例出现腋神经损伤、螺钉松动、钢板断裂、肩峰撞击综合征以及肱骨头坏死。肩关节外展、前屈功能好。结论 经小切口三角肌入路复位微创固定肱骨近端骨折手术创伤小、出血少、愈合快、并发症少、功能恢复好，是一种安全、微创、有效的治疗方法。 |
| 英文摘要: |
| Objective To discuss the clinical results of the treatment of proximal humerus fractures through a small incision into the deltoid and minimally internal fixation. Methods In the period from Jan. 2009 to Dec. 2013, 48 cases of proxinmal fractures were treated in our department, including 20 cases of type Ⅱ, 24 cases of type Ⅲ, and 4 cases of type Ⅳ according to Neer classification. Starting from 1.5 cm anterior to the acromion, the skin was incised for 3-5 cm in length and the deltoid muscle was separated along the muscle fibers to expose the fracture fragments. Under the direct vision the indirect reduction of the fracture was done. On the muscle layer surface, the steel plate was inserted toward the distal end. The proximal and distal ends of the fractures were fixed by the locking nails. Results The operative time in this group was 30-60 min (mean 40 min), intraoperative blood loss was 30 to 100 mL, and postoperative hospital stay was 3-7 days. The incisions obtained stage Ⅰ healing. All cases were followed up fro 12-24 months. All fractures healed. According to Neer functional score, excellent, good and fair effectiveness was obtained in 42, 4, 2 cases respectively. No axillary nerve injury, the self-contained screw loosening, steel plate fracture, shoulder peak impact syndrome and humerus head necrosis occurred. The abduction and anteflexion functions of the shoulder joints were satisfactory. Conclusion The small incision via the Deltoid muscle approach for the reduction of minimally invasive fixation of proximal humerus fractures had advantages of minimally surgical trauma, less bleeding, fast healing, fewer complications and satisfactory functional recovery. |
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