新鲜肱骨近端骨折并肩关节脱位25例诊治分析

目的 探讨新鲜肱骨近端骨折合并肩关节脱位的疗法和效果.方法 治疗新鲜肱骨近端骨折合并肩关节脱位25例,受伤至就诊时间为1～22h,平均14h.手法复位成功6例,手术切开复位内固定19例.结果 肱骨近端骨折25例均得到随访,时间6～20个月,平均13.4个月.骨折愈合时间3～10个月.根据JOA肩关节疾患治疗成绩评定标准：优15例,良6例,可3例,差1例,优良率84%.结论 对于新鲜肱骨近端骨折合并肩关节脱位的治疗,手术切开复位内固定是治疗首选,术后辅以系统主动功能锻炼和康复治疗.

Treatment Experience for the Acute Proximal Humeral Fracture Complicated with Dislocation of Shoulder in 25 Cases

Objective To investigate the optimal treatment strategies and evaluate the efficacy of the proximal humeral fracture complicated with dislocation of shoulder. Method From January 1998 to December 2009,25 cases of the proximal humeral fracture complicated with dislocation of shoulder were treated,in which 6 cases with manipulative reduction and the other with open reduction internal fixation.The mean interval was 14 hours between injury and seeing a doctor（range, l - 22 hour＇s）. Result All 25 patients were available at follow up with mean duration of 13.4 months （range, 6 -20 months）.The union time of fracture was 3-10 months. According to JOA score,the results were excellent in 15 cases,good in 6 cases,fair in 3 case and poor in 1 case respectively. The rate of excellent and good was 84%. Conclusion We suggest that the open reduction internal fixation with systematical postoperative rehabilitation training should be the preferred treatment strategies for the proximal humeral fracture complicated with dislocation of shoulder.