Clinical study of two approaches for the treatment of proximal humerus fractures / 中国综合临床

ABSTRACT

Objective To evaluate the effect of locking plate in the treatment of proximal humerus fractures and to compare the results of two approaches used for fixation.Methods Surgical treatment of 47 cases of proximal humerus fractures in the elderly in Affiliated Hospital of Yan′an University from September 2014 to September 2015.All fractures were randomly divided into two groups and treated with Phlios plate.Deltoid splitting and deltopectoral approaches were used for fixation respectively 23 cases and 24 cases.Postoperative shoulder function was evaluated according to Neer Score.Results The operation time,length of incision,intraoperative bleeding,fracture healing time,length of hospitalization in thoracic deltoid muscle group were more than deltoid splitting pathway group((90.1±6.3) min vs.(73.0±9.5) min,(10.0±3.5) cm vs.(6.3±2.6) cm,(100.0±30.1) ml vs.(90.6±36.4) ml,(3.2±0.8) months vs.(3.0±0.7) months,(10.3±1.9) d vs.(10.1±1.9) d),the difference of operation time(t=2.133,P=0.042) and length of incision(t=2.236,P=0.036) was statistically significant between the two groups,while the difference of the intraoperative bleeding(t=1.867,P=0.063),fracture healing time(t=1.064,P=0.242) and length of hospitalization(t=0.667,P=0.256) were not statistically significant.Followed up for 6.0-12.0 months,the average was (9.0±2.0) months,all patients achieved the bony healing.During the followed up,5 complication(10.6%) were encountered,including 2 cases of varus malunion,1 case of acromial impingement(115°-124°),1 case of screw cut-out and 1 case of humerus head osteonecrosis.The patients with tow-or three parts fractrues in tow groups,Neer-Score scores were statistically significant ((76.8±2.8) points vs.(76.1±2.6) points,(78.9±2.3) points vs.(77.8±2.4) points,t=2.76,2.58,P0.05).The excellent-good rate in triangle muscle splitting approach group was 91.3%(21/23),of thoracic deltoid muscle group was 58.3%(14/24),there were significant different existed in two groups(P=0.023).Conclusion Locking plate for the treatment of proximal humerus fractures has a good effect.Deltoid splitting approach in the prognosis of function recovery has more advantages.