两种不同入路自体髂骨块支撑植骨联合锁定钢板固定治疗肱骨近端Neer三、四部分骨折的临床效果OA

Objective To investigate the clinical effects of autologous iliac crest bone graft via two different approaches combined with locking plate fixation in the treatment of Neer three-and four-part fractures of the proximal humerus.Methods From January 2022 to January 2024,80 patients with Neer three-and four-part fractures of the proximal humerus were selected and divided into observation group(heads,n=40)and control group(tails,n=40)by coin toss.The control group underwent surgery via the deltopectoral approach,while the observation group underwent surgery via the minimally invasive deltoid approach.The surgery-related parameters,therapeutic effects and occurrence of complications were compared between the two groups.The shoulder function of the two groups was evaluated and compared by Constant-Murley shoulder score before surgery and at 1 month,3 months and 6 months after surgery.The shoulder range of motion(ROM)[abduction,flexion,external rotation ROM,hand-to-back(HTB)distance]was measured before surgery and at 6 months after surgery and compared between the two groups.Visual analogue scale(VAS)was used to evaluate and compare the pain status of the two groups before surgery and at 3 d,3 months and 6 months after surgery.Results The intraoperative blood loss in observation group was less than that in control group,and the duration of surgery,incision length,bed rest time and length of hospitalization were shorter compared with the control group(P<0.05).The total effective rate of treatment in observation group was 90.00%(36/40),which was higher than 67.50%(27/40)in control group(P<0.05).At 1 month,3 months and 6 months after surgery,Constant-Murley shoulder score in both groups was higher than that before surgery,and the scores in observation group were higher;the scores of the two groups were increased significantly over time(P<0.05).At 6 months after surgery,the degrees of abduction,flexion and external rotation ROM were increased in both groups,which were greater in the observation group(P<0.05).The HTB distance in both groups was shorter than that before surgery,which was shorter in the observation group(P<0.05).At 3 d,3 months and 6 months after surgery,the VAS pain score was lower in both groups than that before surgery,and the score was lower in observation group(P<0.05).There was no significant difference in the occurrence of complications between the two groups(P>0.05).Conclusion Autologous iliac crest bone graft via the minimally invasive deltoid approach combined with locking plate fixation has significant effects in the treatment of Neer three-and four-part fractures of the proximal humerus.It can accelerate the rehabilitation process,resulting in better postoperative shoulder function,less pain and better safety profile.