本文選題：肱骨近端骨折 + 擴展劈三角肌入路��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的： 比較擴展劈三角肌入路、胸三角肌入路兩種不同手術(shù)入路治療肱骨近端骨折的臨床療效的差異，為不同肱骨近端骨折切開復(fù)位鋼板內(nèi)固定入路選擇提供依據(jù)。 方法： 對2012年8月至2014年8月在吉林大學(xué)第一醫(yī)院創(chuàng)傷骨科收治的肱骨近端骨折患者，符合應(yīng)用鋼板內(nèi)固定，且分別行胸三角肌入路和擴展劈三角肌入路的患者為33例，摔傷為27例，車禍為5例，電擊傷1例。其中應(yīng)用擴展劈三角肌入路13為A組，應(yīng)用胸三角肌入路20例為B組。對所有患者進行病例記錄查詢、門診以及電話隨訪，隨訪時間12～24個月，平均16.4個月。對兩組患者的手術(shù)時間、手術(shù)切口、圍手術(shù)期失血量、住院時間、愈合時間、Constant-Murley評分等指標進行分析。應(yīng)用SPSS17.0軟件對數(shù)據(jù)進行統(tǒng)計分析。 結(jié)果： A組，，手術(shù)時間：79.54±7.30min，手術(shù)切口：10.00±2.16cm，圍手術(shù)期失血：100.38±16.64ml，住院時間：8.38±3.01d，愈合時間：102.07±14.07d,Constant-Murley評分(3個月，12個月)：71.38±5.30分，83.08±5.88分。B組，手術(shù)時間：88.05±8.04min，手術(shù)切口：13.45±2.26cm，圍手術(shù)期失血量119.00±24.63ml，住院時間：8.90±3.61d，愈合時間：96.40±19.69d,Constant-Murley評分(3個月，12個月)：64.55±5.12分，79.15±7.19分。術(shù)后傷口均一期愈合，骨折均骨性愈合，未發(fā)生切口感染、螺釘松動、螺釘切割、肱骨頭壞死等并發(fā)癥。比較兩組患者住院時間、愈合時間、術(shù)后12個月Constant-Murley評分，擴展劈三角肌入路優(yōu)于傳統(tǒng)入路，但無明顯統(tǒng)計學(xué)差異。兩組患者在手術(shù)時間、手術(shù)切口、圍手術(shù)期出血量、術(shù)后3個月Constant-Murley評分上擴展劈三角肌入路優(yōu)于胸三角肌入路，且兩組比較差異有統(tǒng)計學(xué)意義（P＜0.05）。 結(jié)論： 1、擴展劈三角肌入路具有軟組織損傷少，暴露好，肩關(guān)節(jié)功能恢復(fù)快，適用于老年低能量損傷所致肱骨近端骨折。 2、對于高能量損傷所致的，三角肌發(fā)達的年輕患者，胸三角肌入路相對安全，利于復(fù)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 鹵7.30 min, the operative incision was 10. 00 鹵2. 16 cm, the perioperative blood loss was 10 0.38 鹵16. 64 ml, the hospitalization time was 8. 38 鹵3. 01 days, the healing time was 10. 102. 07 鹵14. 07 days and Constant-Murley score (3 months, 12 months: 71. 38 鹵5. 30 鹵83. 08 鹵5. 88, group B). The operative time was 88.05 鹵8.04 min, the operative incision was 13. 45 鹵2. 26 cm, the blood loss was 119.00 鹵24. 63 ml, the hospitalization time was 8. 90 鹵3. 61 days, the healing time was 9. 96. 40 鹵19. 69 days and Constant-Murley score (3 months, 12 months): 64.55 鹵5. 12 minutes 79.15 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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本文編號：1945147