肱骨头骨折伴肩关节脱位的外科治疗

目的分析不同手术方法治疗肱骨头骨折伴肩关节脱位的近期临床效果.方法采用可吸收螺钉结合减张缝合线固定修复、肱骨近端锁定钢板固定、人工肱骨头置换等治疗12例肱骨头骨折伴肩关节脱位患者。结果12例均获随访，时间10-16（13±1．8）个月.10例术后3个月骨折基本愈合，1例12个月出现假体松动伴骨融解，1例10个月出现肩关节半脱位.肩关节活动范围：屈129°±26°．伸32°±9°，展121°±16°，采用Neer评分标准评定治疗效果达（80±5）分.结论肱骨头骨折伴肩关节脱位需根据患者年龄、骨质条件、骨折类型等采用个体化的外科治疗，术后早期功能练习，可获得满意的近期临床效果.

Surgical treatment of proximal humeral fracture-dislocation

Objective To investigate the short-term effect of proximal humeral fracture-dislocation by different surgical treatments. Methods 12 cases with proximal humeral fracture-dislocation were undergone internal fixation with absorbable screws and the special tension suture silk, locking compression plate or artificial head of humerus replacement. Results All patients were followed up for 10 - 16 months（ 13 ±1.8 months ）. 10 cases achieved clinical union 3 months after operation. 1 was complicated with the prosthesis loosening and osteolysis 12 months after operation. 1got subluxation of the shoulder joint 10 months after operation. The rang of motion of shoulder was restored to flexion 129°± 26° ,extension 32°± 9°, abduction 121°±16°. Neer scores were restored to （80 ±5 ）on average. Conclusions To the patients with proximal humeral fracture-dislocation, individual surgical treatment should be adopted on the basis of age of the patient, the bone stoek and the classification of fracture.