手术治疗肱骨近端骨折38例临床分析

目的：探讨肱骨近端骨折手术治疗的方法及疗效。方法：对38例肱骨近端骨折的患者采用Neer分类，二部分骨折23例，三部分骨折10例，凹部分骨折5例。其中18倒二部分骨折采用闭合复位克氏针内固定；5例二部分骨折及6例三部分骨折采用有限切开复位三叶草钢板内固定；4例三部分骨折及2例四部分骨折采用切开复位肱骨近端锁定钢板内剖定；3例四部分骨折采用人工肱骨头置换。术后进行早期合理的功能锻炼。结果：术后随访5—40个月，平均20．1月。所有行内固定术者骨折均愈合，无发生畸形愈合。愈合时间为6-10周。平均8周、人工肱骨头置换术者，未出现段体松动等并发症。对术后所有患肩功能采用Michael Reese医疗中心评分标准进钉评估，其中优良率86．84％。结论：通过术前对患者的骨折情况进行充匀的评估，选用合迫的手术方莱，术后给予积极合理的功能锻炼，往往能取得良好的治疗效果。

The Clinical Analysis of Surgery for 38 cases Proximal Humeral Fractures

Objective： To investigate the operation treatment methods and the curative effect of proximal humeral fracture. Method：38 patients with proximal humerus fracture, who were divided by Neer classification, the two part fractures in 23 eases, the three part fractures in 10 cases, the four part fractures in 5 cases. Among 18 eases of two part fraetures by closed reduction and internal fixation with Kirschner wire, In 5 cases of two part fractures and 6 eases of three part fracture by limited open reduction and Clover plate internal fixation ; In 4 cases ＇of three part fractures and 2 cases of four part fiactures with open reduction and internal fixation with locking proximal humeral plate ; In 3 cases of four part fractures of the humeral head replacement. By early postoperative reasonable function exercise. Result： Postoperative follow-up 5-40 months, An aver- age of 20.1 months. All underwent internal fixatio, of the fractures healed, no rectofence of deformity heal- ing. Healing time was 6-10 weeks, an average of 8 weeks, artificial humeral head replacement,no loosening of prostheses and complications. On postoperative shoulder function all by Michael Reese Medical Center scoring criteria for the assessment, The excellent and good rate was 86.84%. Conclusion： Through the pre- operative patients of fracture are adequately assessed, selection of suitable operation scheme, Alter giving a positive rational function exercise, can obtain good therapeutic effect.