青壮年患者肱骨近端严重骨折脱位的内固定治疗

目的探讨青壮年患者肱骨近端严重骨折脱位行锁定钢板内固定保头治疗的临床疗效。 方法回顾性分析荆门市第一人民医院自2012年6月至2017年6月收治的24例肱骨近端严重骨折脱位患者的临床资料,其中男15例，女9例；年龄31~59岁，平均39.2岁；右侧8例，左侧16例；本组均为新鲜骨折，骨折按Neer分型：三部分6例，四部分18例；肱骨头前脱位21例，肱骨头后脱位3例。记录手术时间、术中出血量、住院时间，观察切口愈合、骨折愈合情况及术后并发症情况，末次随访采用Neer肩关节功能评分标准评定肩关节功能。 结果本组患者获随访12~37个月，平均19.7个月；手术时间69~113 min，平均82.3 min；术中出血量100~500 ml，平均197.5 ml；住院时间6~14 d，平均8 d；患者切口均Ⅰ期愈合，末次随访时21例患者骨折获得临床愈合，1例患者术后半年发现感染，后分期行人工肱骨头置换治疗，2例患者出现肱骨头坏死，但患者自觉可耐受未行特殊处理。术后肩关节前屈活动范围82°~165°，平均136°；后伸活动范围20°~45°，平均40°；外展活动范围87°~170°，平均147°；内旋活动范围L5~T9水平，平均L1水平；与术前比较差异均有统计学意义（P<0.05 ）。根据Neer肩关节功能评分标准：优8例，良11例，可4例，差1例，总体优良率79.17%。 结论对于青壮年患者肱骨近端严重骨折脱位行锁定钢板内固定保头治疗，临床疗效较好，也是一种治疗选择。

Internal fixation for treatment of severe proximal humeral fracture-dislocation in young adults

BackgroundProximal humeral fracture accounts for about 5% of all fractures, and epidemiological studies in China have shown that proximal humeral fracture accounts for 13.5% of hospitalized patients with periarticular fracture. However, the cases of severe proximal humeral fracture combined with humeral head dislocation are rare in clinical practice. For elderly osteoporosis patients with severe proximal humeral fracture and humeral head dislocation, it is currently accepted that shoulder arthroplasty is preferred. But for young adults, the choice of surgical methods is often controversial. Due to the complex type of proximal humeral fractures and special anatomical structure, the operative manipulation of open reduction and internal fixation as well as humeral head preservation is difficult. There are a series of postoperative complications such as plate breakage, nail withdraw, screw penetration, infection, etc., and high incidence of humeral head necrosis is reported in the literatures, which has always been a major challenge for surgeons of shoulder and elbow trauma. Objective To investigate the clinical efficacy of locking plate internal fixation for treatment of severe proximal humeral fracture-dislocation in young adults. MethodsFrom June 2012 to June 2017, 24 patients (15 males and 9 females) with severe proximal humeral fracture-dislocations were treated in our hospital, and the clinical data were retrospectively analyzed. The ages ranged from 31-59 years with an average age of 39.2 years. There were 8 right-sided cases and 16 left-sided cases. All the fractures were fresh, and according to Neer classification, there were 6 three-part cases and 18 four-part cases. Twenty one cases were anterior dislocations, and 3 cases were posterior dislocations. The operation time, intraoperative blood loss, and hospitalization duration were recorded, and the incision healing, fracture healing and postoperative complications were observed. The shoulder function was evaluated by Neer scoring system in the last follow-up. ResultsThe patients were followed up for 12 to 37 months, with an average of 19.7 months. The operation time was 69-113 minutes with an average of 82.3 minutes. The intraoperative blood loss was 100-500 ml with an average of 197.5 ml. The hospital stay was 6 to 14 days with an average of 8 days. All the incisions healed at the first stage. At the last follow-up, 21 patients had clinical healing, 1 patient was found to have infection half a year after operation and treated with humeral head replacement at the secondary stage, and 2 patients developed humeral head necrosis but refused further treatment. The postoperative range of anterior flexion was 82°-165° with an average of 136°, the postoperative range of backward flexion was 20°-45° with an average of 40°, the range of abduction was 87°-170° with an average of 147°, and the range of internal rotation was L5 to T9. There was statistical significance between the postoperative ranges of motion and the preoperative ones (P<0.05) . According to Neer scoring system, there were 8 excellent case, 11 good cases, 4 moderate cases, and 1 poor case. The overall excellent and good rate was 79.17%. ConclusionsFor the treatment of severe proximal humeral fracture-dislocation in the young patients with locking plate internal fixation, the clinical efficacy is better, which is also a treatment option.