手法闭合复位经皮微创固定治疗肱骨近端骨折

目的：探讨手法闭合复位经皮微创固定治疗肱骨近端骨折的临床效果。方法：2008年4月至2010年3月，采用手法闭合复位经皮微创固定治疗肱骨近端骨折患者28例，男21例，女7例；年龄22～78岁，平均42．6岁；受伤至手术时间平均1．7d；摔伤19例，车祸伤9例。临床表现为肩部疼痛肿胀，活动受限。根据Neer分型：二部分骨折17例，三部分骨折11例。在手法闭合复位后，采用锁定接骨板经肩峰下三角肌小切口微创内固定进行治疗。观察手术时间、出血量和切口长度，并采用Constant—Murley绝对值评分对疗效进行评定。结果：28例患者手术时间平均40min，出血量平均110ml，手术切口长度平均5．6em。术后x线片显示骨折复位满意，所有钢板螺钉位置良好。28例均获随访，时间6～24个月，平均14．2个月。所有骨折在术后6～8周愈合，无延迟愈合和不愈合，无固定失败。随访期无肱骨头坏死病例，24例无肩痛，4例偶有肩痛，所有患者均能完成日常生活动作，平均Constant—Murley绝对值评分（91．0＋5．8）分，其中优24例，良3例，可1例。结论：手法复位经皮微创固定治疗肱骨近端骨折，既将手术的创伤降到最小，又能保证关节的早期功能活动，使得肩关节功能迅速恢复，具有创伤小、血运破坏少、固定可靠等优点。

A study of proximal humerus fractures using close reduction and percutaneous minimally invasive fixation

Objective: To investigate the clinical effects of close reduction and percutaneous minimally invasive fixation in the treatment of proximal humerus fractures. Methods: From April 2008 to March 2010, 28 patients with proximal humerus fracture were treated with close reduction and percutaneous minimally invasive fixation. There were 21 males and 7 females, ranging in age from 22 to 78 years, with an average of 42. 6 years. The mean time from suffering injuries to the operation was 1. 7 d. Nineteen cases caused by falling down, 9 cases by traffic accident. The main clinical manifestation was swelling, pain and limited mobility of shoulders. According to Neer classification, two part fractures were in 17 cases and three part fractures in 11 cases. The locking proximal humerus plate was used to minimally fixation through deltoid muscle under acromion. The operating time, volume of blood loss, the length of incision and Constant-Murley assessment were applied to evaluate the therapeutic effects. Results: The mean operating time was 40 min, the mean blood loss was 110 ml, and the mean length of incision was about 5. 6 cm. The postoperative X-ray showed excellent reduction and the plate and screws were successfully place. Twenty-eight patients were followed up for 6 to 24 months(averaged 14. 2 months). The healing time ranged from 6 to 8 weeks and all incision was primarily healed. There were no cases with necrosis head humerus, 24 cases without omalgia, and 4 cases with omalgia occasionally. All the patients can complete the daily life. The mean score of Constant-Murley assessment was 91. 0±5. 8, 24 cases got an excellent result, 3 good and 1 fair. Conclusion: Close reduction and percutaneous minimally invasive fixation, not only can reduce surgical invasive, but also guarantee the early function activities. It has the advantages of less invasive, fixed well and less damage of blood circulation.