Abstract：Objective This work aimed to investigate the influence and technological advantage of the subacromial anterolateral approach on the clinical effect of Neer Ⅲ proximal humeral fractures. Methods A retrospective cohort study was adopted. Thirty cases from Wuhu Traditional Chinese Medicine Hospital (August 2017-May 2020), including 4 males and 26 females aged 48-81 (65.5±10.8) years old, were enrolled. Among them, 13 cases had fractures on the left, and 17 cases had fractures on the right. All patients underwent open reduction and internal fixation. Analysis involved a comparison of the two different surgical approaches in terms of incisions, blood loss, fracture healing, pain level, shoulder function, and others. Specifically, 30 cases were divided into two groups, including the control group (n=16, deltoid and pectoralis major approach) and the observation group (n=14, anterolateral acromion approach). The patients' pain level at preoperative stage and at 1, 3, and 6 months after surgery was assessed using the visual analogue scale (VAS). The function of the injured shoulder was evaluated at preoperative stage and at 1, 3, and 6 months after surgery using the Constant-Murley scoring method. Results The two groups had no significant differences in gender, age, and operation side (all P values >0.05). The incision length, blood loss, and fracture healing time of the observation group were (6.2±1.9) cm, (101.8±57.9) mL, and (12.4±1.0) weeks, whereas those of the control group were (10.0±0.8) cm, (163.8±91.1) mL, and (13.9±2.0) weeks, respectively. The difference between the two groups was statistically significant (t=7.31, 2.19, 2.54, all P values <0.05). The VAS scores of the observation and control groups were (7.9±0.5) and (7.9±0.7) points, (1.4±0.6) and (1.4±0.9) points at preoperative stage and 6 months after surgery, respectively, and no significant differences were found between the two groups (all Pvalues=1.000). The VAS scores of the observation group at 1 and 3 months after surgery were (4.4±0.7) and (2.4±0.5) points, whereas those of the control group were (5.1±0.7) and (3.1±0.9) points, respectively. The observation group had a lower VAS score at 1 and 3 months after surgery, and the difference was statistically significant (t=2.73, 2.58, all P values <0.05). The Constant-Murley scores of the observation and control groups were (33.1±1.4) and (32.8±1.5) points, respectively, at preoperative stage. There were no significant differences between the two groups (t=0.56, P=0.580). The Constant-Murley scores of the observation group at 1, 3, and 6 months after surgery were (56.6±3.8), (71.8±3.2), and (82.9±4.1) points, respectively. The Constant-Murley scores of the control group were (49.4±4.2), (68.5±4.0), and (79.9±3.4) points, respectively. For the Constant-Murley score, the observation group had higher scores at 1, 3, and 6 months after surgery compared with the control group, The difference was statistically significant (t=4.90, 2.47, 2.19, all P values <0.05). Conclusion Relative to the deltoid and pectoralis major approach, the anterolateral acromion approach is more suitable for the surgical treatment of Neer Ⅲ proximal humeral fractures. because it has a small incision and has advantages of less blood loss, less pain, and faster recovery of shoulder function.
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2022, Vol. 27 
