肱骨近端粉碎性骨折切开复位内固定技巧及方法探讨

目的：探讨采用切开复位内固定术治疗肱骨近端粉碎性骨折的疗效是否显著,以及应用不同的内固定物是否对治疗结果有较大影响。方法：自2003年1月至2007年6月应用切开复位内固定术治疗肱骨近端粉碎性骨折423例。其中采用钢丝张力带内固定139例,男51例,女88例,年龄35～72岁,平均55.8岁;采用三叶草钢板内固定103例,男48例,女55例,年龄22～76岁,平均56.7岁;采用锁定钢板内固定181例,男85例,女96例,年龄29～77岁,平均57.1岁。应用Constant肩关节评分对术前、术后患者肩关节疼痛、日常活动、活动范围、力量等进行评定。结果：423例患者术后伤口均Ⅰ期愈合。对所有患者进行12个月的随访,其症状和体征获得了明显改善。应用Constant肩关节评分,术前、术后患者肩关节功能评分存在显著性差异;而3组应用不同内固定物的患者,其肩关节功能评分未见显著性差异。结论：切开复位内固定术是治疗肱骨近端粉碎性骨折较理想的方法,而不同的内固定物对治疗效果的影响无显著性差异。

Study of the treatment of comminuted fractures of proximal humerus with open reduction and internal fixation

Objective: To study the effect of the treatment for comminuted fractures of proximal humerus with open reduction and internal fixation,and the influence of the different internal fixation. Methods: From January 2003 to June 2007,423 cases of comminuted fractures of proximal humerus were treated with open reduction and internal fixation. Among them,139 patients included 51 males and 88 females were treated with the Kirschner needle with an average age of 55.8 years old ranging from 35 to 72 years,and the average course was 7 days(from 3 to 20 days);103 patients included 48 males and 55 females were treated with the cloverleaf plate with an average age of 56.7 years old(from 22 to 76 years),and the average course was 8.5 days(from 3 to 23 days); 181 patients included 85 males and 96 females were treated with the locking plate with an average age of 57.1 years old (from 29 to 77 years),and the average course was 7.9 days (from 3 to 21 days). The pain,daily activities,orbit,and the strength of the shoulder were evaluated with the Constant's scale. Results: The wound of all the cases was primary healing. All patients were followed-up for over 12 months,the sings and symptoms of all the patients were improved very well. There was significant difference between before and after operation on Constant's scoring. While there was not significant difference among the different internal fixation. Conclusion: Open reduction and internal fixation is effective for comminuted fractures of proximal humerus. There is not significent difference on therapeutic efficacy in different internal fixation.