闭合或有限切开经皮穿针固定治疗肱骨近端两部分骨折

目的：通过分析28例闭合或有限切开经皮穿针固定治疗肱骨近端两部分骨折的临床疗效，探讨治疗体会及教训。方法：2005年11月至2006年11月采用闭合或有限切开经皮穿针固定治疗肱骨近端两部分骨折28例，男12例，女16例；年龄31-73岁，平均54．7岁。均为新鲜骨折。骨折根据Neer分型：两部分外科颈骨折18例，外展嵌插两部分大结节骨折10例。结果：本组平均手术时间42min,口均Ⅰ期愈合，X线片显示骨折对位满意，向前成角基本矫正。外展嵌插两部分大结节骨折的颈干角从术前的平均175°（160°-200°）恢复至平均136°（128°～142°），大结节移位小于3mm。随访6-13个月，平均10．3个月，骨折均愈合，未出现肱骨头缺血坏死现象，术后8—10周取出内固定。根据ASES及Constant-Murley肩关节评分系统，本组ASES评分平均91．2分（63～100分），Constant—Mudey评分平均90．4分（67-100分）。本组优12例，良14例，一般2例。结论：闭合或有限切开经皮穿针固定治疗肱骨近端两部分骨折的操作有相当难度，且须在透视下进行，但具有损伤小、康复快的优点，是治疗特定类型肱骨近端骨折的有效方法。骨质情况是决定固定稳定程度的必要条件。

Treatment of two-part proximal humeral fracture with closed or mini-open assisted reduction and percutaneous pinning

Objective: To discuss the therapeutic effects of closed or mini-open assisted reduction and percutaneous pinning for the treatment of two-part proximal humeral fracture. Methods: Twenty-eight patients with two-part proximal humeral fractures were treated with closed or mini-open assisted reduction and percutaneous pinning from November 2005 to November 2006. There were 12 males and 16 females. The mean age was 54.7 years,ranging from 31 to 73 years. The two-part proximal humeral fractures of 28 patients were all fresh fractures. According to Neer classification,there were 18 patients with two-part surgical neck fractures and 10 patients with impacted valgus two-part greater tuberosity fractures. Results: The average operation time was 42 minutes and the wound healed at the primary stage. The X-ray showed all fracture had good reduction with almost no anterior angulation. The average neck shaft angle was changed from 175°(ranged,160° to 200°)preoperatively to 136°(ranged,128° to 142°)postoperatively,and the displacement of greater tuberosity was reduced to less than 3 mm postoperatively in impacted valgus two-part greater tuberosity fracture group. The average clinical follow-up time was 10.3 months(ranged,6 to 13 months). All fractures healed and had no avascular necrosis of the humeral head. The wires were removed 8 to 10 weeks post-op. According to the shoulder score of Constant-Murley and ASES,the mean ASES score was 91.2 points(ranged,63 to 100 points) and Constant-Murley score was 90.4 points(ranged,67 to 100 points). After the treatment,12 cases got an excellent result,14 good and 2 moderate. Conclusion: Closed or mini-open assisted reduction and percutaneous pinning is not as easy as it looks and must be applied with fluoroscopy. But it is the effective method for managing the certain types of proximal humeral fracture with the advantage of less injury and faster recovery. The bone condition of proximal humerus is the key factor to the stability of fixation.