肱骨近端移位骨折的手术治疗

目的：总结肱骨近端移位骨折的手术治疗方法和疗效。方法：分析手术治疗肱骨近端骨折28例资料。患者平均年龄24．4岁，平均随访2年6个月；手术均采用三角肌胸大肌间隙入路，钢板固定15例，交叉克氏针固定11例，单纯螺丝钉固定15例；采用Neer分类及评分方法评价手术结果。结果：两部分外科颈骨折优良率为64．7％，无头坏死及不愈合，三部分骨折和四部分骨折切开复位的满意率较低。结论：两部分骨折和三部分骨折可采用切开复位内固定，但尽量避免使用钢板；对四部分骨折，内固定满意率较低且肱骨头坏死率较高。

Operative Treatment of Displaced Proximal Humeral Fractures

Objective: To sum up the methods and the results of operative treatment of displaced proximal humeral fractures. Methods: Twenty-eight patients (16 males, 12 females, average age 24.4 years) with dislocated proximal humeral fractures, followed-up averagely two and half years, were retrospectively reviewed. Neer's standards were used to classify the fracture types and to value the operation outcome. The gap between deltoid muscle and pectoral muscle was adopted as operation incision for all cases. Fifteen fractures were fixed with plates, two fractures with screws and eleven fractures with crossed Kirschner wire. Results: The good-excellent outcome of surgical management was 64.7%for patients with two part proximal humeral fracture involved surgical neck. No nonunion or head necrosis appeared. The satisfactory frequency for three or four part fracture with open reduction and internal fixation was rather lower. Conclusion: Open reduction and internal fixation is a better selection for two and three part fracture, however it is not suitable for four part fracture, since it is with high necrosis rate of head.