Analysis on the clinical efficacy of locking plate fixation with different operative approaches for the treatment of proximal humeral fractures / 中国综合临床

ABSTRACT

Objective To evaluate the clinical efficacy of the dehopectoral approach and and the deltoid lateral longitudinal separate approach of locking plate fixation for the treatment of proximal humeral fractures.Methods Fifty-seven cases of proximal humerus fracture treated in Chaoyang Central Hospital from March 2010 to May 2015 were selected and were divided into the conventional group(30 cases)and the treatment group(27 cases)according to the different operative approaches.The patients in the conventional group were treated with locking plate fixation by dehopectoral approach and the patients in the treatment group were treated with locking plate fixation by deltoid lateral longitudinal separate approach.The operation time, intraoperative blood loss,fracture healing time,postoperative complication rate were observed in the two groups.Constant scores at different times after operation and the evaluation of shoulder function recovery were observed in the two groups.Results All patients were followed up for 10-25 months,with an average of 19 months.The blood loss in the treatment group was(89.7± 31.5)ml and the fracture healing time was(79.6 ±1.8)d,compared with(243.1±65.7)ml and(90.1±2)d in the conventional group,the differences between the two groups were statistically significant(P=0.000,0.035).There was no significant difference between the two groups in the operation time(P=0.079).Constant scores in the treatment group at 3 weeks and 3 months after operation were better than those in the conventional group,the differences between the two groups were statistically significant(P<0.05).At the last follow-up,there was no significant difference in Constant scores between the two groups(P>0.05).There were significant differences in the incidence of postoperative complications between the conventional group and the treatment group(13.3% vs.3.7%,P = 0.045).Conclusion In the treatment of proximal humeral fractures,the deltoid lateral longitudinal separate approach has advantages of less intraoperative blood loss,shorter fracture healing time,faster recovery of shoulder function and less postoperative complications,which is a safe and effective method for the treatment of proximal humeral fractures.