肱骨近端移位骨折的手术治疗(附31例随访分析)

目的 总结治疗肱骨近端移位骨折的手术方法及结果。方法 手术治疗肱骨近端骨折３１例，男１８例，女１３例，平均年龄３６．８岁，平均随访时间４０．５个月；手术均采用三角肌胸大肌间隙入路，钢板固定１２例，单纯螺钉固定１５例，克氏针加石膏固定４例；采用Ｎｅｅｒ分类及评分方法评价手术效果。结果 两部分外科颈骨折优良率为６９％，无坏死及骨折不愈合；三部分骨折和四部分骨折切开复位内固定的满意率较低；三部分骨折的肱

Operative treatment of displaced proximal htmeral fractures: follow-up and analysis of 31 patients

Objective To study the methods and the results of operative treatment of displaced proximal humeral fractures. Methods We reviewed thirty one patients who had been diagnosed as having displaced proximal humeral fractures and had been operated on from July 1989 to December. 1998 in our hospital.The mean follow up time was 40 5 months (8 124 months). Their age ranged from 15 to 62 years (average, 36 8 years); 18 patients were male and 13 female. Neer fracture classification system and rating system were used. In all patients, delto pectoral approach was adopted. Twelve fractures were fixed with plates, fifteen fractures with screws, and four fractures with Kirschner wire and plaster. Results Of two part surgical neck fractures, nine of thirteen patients (69%) were excellent or good with no necrosis and nounion. In three part or four part fractures, the rate of satisfaction with open reduction and internal fixation (ORIF) was rather lower. In three part fractures, the rate of humeral head necrosis was 44%, and in four part fractures, over 75%. Conclusions In two part and three part fractures, ORIF is a better treatment, but care shoald be taken to avoid using plates. As for classic four part fractures, the rate of satisfaction with ORIF is poor and the rate of necrosis is higher.