中文摘要：

目的探讨改良肩关节外侧入路和三角肌胸大肌入路结合肱骨近端锁定加压接骨板（proximal humeral internal locking system PHILOS，SYNTHES，Switzerland）治疗老年肱骨近端骨折的疗效。方法自2012年5月至2015年2月收治40例新鲜老年肱骨近端骨折患者，男18例，女22例。根据手术方式不同分为常规组（采用三角肌胸大肌入路，20例）和微创组（采用改良肩关节外侧入路，20例）。分析比较术中出血量，手术时间，术中与术后并发症以及术后1个月、3个月和末次随访Constant评分，随访时复查患肩的x线正侧位片。结果所有患者均获得随访，时间7—33个月，平均16个月。均无切口感染，均获骨性愈合。微创组术中出血量、手术时间、切口长度及愈合时间均明显优于常规组，差异有统计学意义（P〈0．05）。术后1个月、3个月微创组患者Constant评分56．7±5．9、83．1±6．4，均优于常规组41．8±5．2、78．1±6．8，差异均有统计学意义（P〈0．05）。但末次随访时微创组患者Constant评分85．2±53与常规组84．6±5．8比较，差异无统计学意义（P〉0．05）。常规组术中2例出现头静脉损伤。结论改良肩关节外侧入路较三角肌胸大肌入路治疗肱骨近端骨折具有创伤更小、恢复快等优点，是一种治疗老年肱骨近端骨折的优良方法。

英文摘要：

Objective： To compare the clinical effects of proximal humerus locking compression plate （PHILOS） through the modified lateral approach and deltopectoral approach in the treatment of senile proximal humeral fractures. Methods From May 2012 to February 2015, 40 patients with flesh senile proximal humeral fractures were treated in our department. There were 18 males and 22 females. According to the surgical approach they were divided into 2 groups： conventional group （the deltopectoral approach） of 20 patients and minimally invasive group （the modified lateral approach） of 20 patients. They were treated by PHILOS fixation. The intraoperative blood loss, operation time, intraoperative and postoperative complications, Constant scores at 1 month, 3 months and the last follow-up, as well as X-ray films of the affected shoulder at follow-up, were analyzed and compared between the 2 groups. Results All the 40 cases were follow- up for an average of 16 months （range, 7 to 33 months）. No incision infection occurred and bony union was all achieved. The minimally invasive group were significantly better than the conventional group in blood loss, operation time, incision length and union time （P〈0.05）. The Constant scores at 1 month and 3 months postoperatively in the minimally invasive group （56.7±5.9 and 83.1±6.4） were significantly higher than those of the conventional group （41.8±5.2 and 78.1±6.8, P〈0.05）. However, there was no significant difference between the 2 groups in the Constant scores at last follow-up （85.2±5.3 versus 84.6＋5.8, P〉0.05）, In the conventional group, cephalic vein injury occurred in 2 cases. Conclusion The modified lateral approach applied in the treatment of proximal humeral fractures has the advantages of less trauma and quicker recovery, which provides a good alternative for senile proximal humeral fi＇actures.