肱骨近端骨折的手术治疗策略

目的探讨不同类型肱骨近端有移位骨折的最佳手术治疗方案。方法对肱骨近端骨折有移位的174例患者，进行Neer分类，122例二部分骨折和8例三部分骨折行三叶草钢板内固定，30例三部分骨折和3例四部分骨折行肱骨近端加压锁定钢板（10cking proximal hunerus plate，LPHP）内固定，而5例三部分骨折和6例四部分骨折行人工肱骨头置换术（humeral head replacement，HHR）。结果内固定术后所有骨折均愈合，无畸形。愈合时间为8—12周，平均10周。肱骨头置换术后，假体未出现松动、脱位等现象。所有病例均无感染、神经、血管损伤等并发症发生。结论对肱骨近端骨折采用手术治疗可取得较为满意的效果。Neer二部分骨折、多数三部分骨折及一些四部分骨折可采用钢板内固定，而部分三部分骨折、多数四部分骨折可根据情况一期行人工肱骨头置换术。

Strategy in Surgical Treatment for Proximal Humeral Fracture

Objective To discuss the best surgical treatment for proximal displaced humeral fractures of different types. Methods Neer classification was made to 174 cases with proximal displaced humeral fracture; 122 cases with two - part fracture and 8 cases with three - part fracture received internal fixation with clover steel plate; 30 cases with three - part fracture and 3 cases with four - part fracture received internal fixation with locking proximal humeral plate （ LPHP ） ; 5 cases with three - part fracture and 6cases with four - part fracture received humeral head replacement （ HHR ）. Results All the internal - fixed fractures healed without malformation, the healing time lasted from 8 to 12 weeks with the average of 10 weeks; in those patients having had HHR, no loosening and dislocation of the prosthesis occurred; no such complications as infection, nerve or blood vessel damages were found in all the 174 cases. Conclusions Surgical treatment for proximal humeral fracture is of satisfactory effect; internal fixation with steel plate may be performed to two - part fractures, most of the three - part fractures and some four - part fractures according to Neer classification, while some two - part fractures and most of the four - part fractures can be first treated with humeral head based on the individual situation.