经三角肌与三角肌胸大肌入路治疗NeerⅡ、Ⅲ型老年肱骨近端骨折的效果比较OA
Comparison of Efficacy of via Deltoid and Deltoid Pectoralis Major Approach in the Treatment of Neer Type Ⅱ and Ⅲ Proximal Humerus Fracture in Elderly Patients
目的:探讨经三角肌与三角肌胸大肌入路治疗NeerⅡ、Ⅲ型老年肱骨近端骨折的效果.方法:选取 2021 年 1 月—2022 年 12 月景德镇市第一人民医院收治的 48 例NeerⅡ、Ⅲ型老年肱骨近端骨折患者,按照不同的手术方式分为观察组(经三角肌入路)和对照组(经三角肌胸大肌入路),各24例.对比两组手术情况、肩关节功能、凝血指标和疼痛程度.结果:观察组术中出血量少于对照组,骨折愈合时间和手术时间均短于对照组,差异均有统计学意义(P＜0.05).观察组术后 1、6 个月Neer肩功能评分均高于对照组,差异均有统计学意义(P＜0.05).观察组术后 3 d凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)均低于对照组,观察组FIB较术前降低,对照组FIB较术前升高,观察组低于对照组,差异均有统计学意义(P＜0.05).观察组术后 3 d疼痛数字评价量表(NRS)评分低于对照组,差异有统计学意义(P＜0.05).结论:NeerⅡ、Ⅲ型老年肱骨近端骨折患者选择经三角肌入路方式进行手术,能够缩短手术时间和骨折愈合时间,减少术中出血量,有利于肩关节功能恢复,改善凝血指标及疼痛程度.
Objective:To investigate the effects of via deltoid and deltoid pectoralis major approach in the treatment of Neer type Ⅱ and Ⅲ proximal humerus fracture in elderly patients.Method:A total of 48 elderly patients with Neer type Ⅱ and Ⅲ proximal humerus fracture admitted to Jingdezhen NO.1 People's Hospital from January 2021 to December 2022 were selected and divided into the observation group(via deltoid approach)and the control group(via deltoid pectoralis major approach)according to different surgical methods,with 24 cases in each group.The situation of surgery,shoulder joint function,blood coagulation indexes and the degree of pain of two groups were compared.Result:The intraoperative blood loss in the observation group was lower than that in the control group,the time of fracture healing and operation were shorter than those in the control group,the differences were statistically significant(P＜0.05).1 month and 6 months after surgery,the scores of Neer shoulder joint function in the observation group were higher than those in the control group,the differences were statistically significant(P＜0.05).3 days after surgery,the prothrombin time(PT)and activated partial thromboplastin time(APTT)of the observation group were lower than those of the control group,the fibrinogen(FIB)of the observation group was lower than that before surgery,the FIB of the control group was higher than that before surgery,that of the observation group was lower than that of the control group,the differences were statistically significant(P＜0.05).3 days after surgery,the score of pain numerical rating scale(NRS)in the observation group was lower than that in the control group,the difference was statistically significant(P＜0.05).Conclusion:The proximal humerus fracture in elderly patients with Neer type Ⅱ and Ⅲ choose the deltoid approach can shorten the time of fracture healing and surgery,reduce the intraoperative blood loss,and is conducive to the recovery of shoulder joint function,improve blood coagulation indexes and the degree of pain.
杨景瑞;程进
景德镇市第一人民医院创伤中心骨科 江西 景德镇 333000
经三角肌胸大肌入路疼痛程度经三角肌入路肩关节功能老年肱骨近端骨折
Via deltoid pectoralis major approachPain degreeVia deltoid approachShoulder joint functionProximal humerus fracture in elderly
《中国医学创新》 2024 (001)
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江西省卫生健康委科技计划项目(202212036)
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