复杂肱骨近端骨折的手术治疗策略及疗效分析

目的 探讨复杂型的肱骨近端骨折在临床外科治疗中的适应证,并分析临床治疗效果.方法 2002年6月～2008年6月,治疗肱骨近端骨折22例,其中男14例,女8例;年龄21～75岁,平均49岁.其中12例选择肱骨近端锁定解剖钢板内固定,其余10例行肩关节置换术.术后3周内颈腕带悬吊,常规进行肩关节功能锻炼.术后6周、半年复查肩关节X线片.结果 22例均获随访,时间7～28个月(平均20个月),无骨折不愈合、钢板松动、感染等并发症.患者分别按Neer、Constant、oxford等肩关节功能评分标准评估.本组病例疗效满意、功能恢复好,随访肩关节活动度、疼痛可视性评分等,均未见显著性差异.结论 复杂的肱骨近端骨折外科治疗是首选,但具体选择肱骨近端解剖钢板还是关节置换,需要结合患者的年龄、骨量以及全身状况合理评估.对复杂肱骨近端骨折患者,与其先行切开复位内固定待其发展到肩关节炎的终末期再行肩关节置换,不如一期进行肩关节置换,让患者尽快重获无痛又能活动的肩关节,改善生活质量.

Surgical Treatment for Complicated Proximal Humeral Fractures and Analysis of Efficacy

Objective To investigate the treatment effects of the different methods on proximal humeral fractures and analyze the indication of the surgical management.Methods From June 2002 to June 2008,22 patients(14 males and 8 females,with average age of 49 years) were treated with surgical treatment.Each case was evaluated postoperatively.Twelve cases were chosen for open reduction and locked plate internal fixation,and others were treated with hemi-arthroplasty.The arm was immobilized in a sling for 3 weeks after...