手法整复经皮导入空心加压螺纹钉内固定治疗肱骨近端骨折脱位

目的：介绍一种治疗新鲜肱骨近端骨折脱位的闭合整复和半开放手术方法，并对其疗效进行评价。方法：对43例肱骨近端骨折合并肩关节前脱位患者应用反“？”手法整复骨折，经皮导入空心螺纹钉内固定后按单纯肩关节前脱位整复治疗。术后2年进行肩关节Neer评分。结果：术后针眼无感染，均工期愈合。螺纹钉无折断。骨折均在术后2个月内愈合。经24～52个月的随访，无肱骨头坏死发生。疗效优35例，良7例，可1例，优良率为97．7％。结论：反“？”手法设计合理，复位率高。经皮导入内固定可靠，无须外固定，术后可早期活动肩关节，有效预防了关节粘连，较好地保护了肱骨头的血供，避免了肱骨头缺血性坏死的发生。

Internal fixation of percutaneous compression hollow screw for the treatment of proximal humeral fracture-dislocation

Objective:To introduce a method for the treatment of proximal humeral fracture-dislocation with closed reduction and semi-open operation and evaluate its clinical effect.Methods:Forty-three patients with proximal humeral fracture-dislocation were firstly treated with the manipulation of reversed "?"and internal fixation with percutaneous compression hollow screw.Clinical effect was evaluated according to Neer's score in two years after operation.Results:The pinholes of all the patients had no infection and achieved primary healing.Screws had not been broken off and fractures were healed in two months after operation.All patients had not been found osteonecrosis of humeral nead during the follow up period (range was from 24 months to 52 months).The clinical result was excellent in 35 cases,good in 7 cases and satisfactory in 1 case.The rate of excellent and good was 97.7%.Conclusion:The manipulation of reversed "?" has the advantages of good design and high reduction rate.The percutaneous internal fixation has the advantages of reliable fixation,need no external fixation,early exercises of shoulder after operation,preventing adhesion of joint effectively.