经三角肌入路微创固定治疗肱骨近端骨折

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疗效。方法2009年1月—2012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44例，根据Neer分型，Ⅱ型16例，Ⅲ型24例，Ⅳ型4例。经肩前外侧三角肌自肩峰下1.5 cm处纵向切开皮肤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，在肌层表面或肌层下向远端插入钢板，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36例，良6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、内收功能好。结论经小切口三角肌入路复位微创固定肱骨近端骨折具备手术创伤小，出血少，愈合快，并发症少，功能恢复好等优点，是一种安全、微创、有效的治疗方法。

Treatment of proximal humerus fracture through a small incision into the deltoid and minimally internal fixation

Objective To disscuss 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 January 2009 to December 2012, 44 cases of proxinmal fractures were treated in our department. According to Neer parting, 16 cases of type II, III type 24 cases, 4 cases of type IV. Starting from 1.5 cm anterior to the acromion, the skin was incised for 3.0～5.0 cm in length and the deltoid muscle was separated along the muscle fibers to expose the fracture fragments. Under direct vison the direct reduction of the fracture, in the muscle layer surface to distal insertion steel plate, nearly far end were put into locking nail fixed provoked. Results This group of 30 ～ 60 minutes of operation time, an average of 40 minutes, intraoperative hemorrhage about 30 ～ 100 ml, need a blood transfusion, postoperative hospitalization time 3 ～ 7 days, were stage I incision healed, all cases received follow-up, time 12 ～ 24 months, all fracture healed, according to Neer functional score 36 cases, 6 cases, 2 cases. No appear axillary nerve injury, the self-contained screw loosening, steel plate fracture, shoulder peak impact syndrome and humerus head necrosis. Shoulder joint outreach, before the function is good. Conclusion Deltoid muscle via a small incision in the reduction of minimally invasive fixation of proximal humerus fractures small surgical trauma, less bleeding, fast healing, fewer complications and good functional recovery advantages, is a safe, minimally invasive and effective method of treatment.