肱骨近端骨折不同方法治疗的疗效分析

目的：分析和比较肱骨近端骨折手术与非手术治疗的适应症、手术方式的选择以及术后康复对患肢功能恢复的重要性。方法：回顾性分析128例肱骨近端骨折，非手术治疗41例，手术治疗77例，手术采用三角肌胸大肌间沟入路，手术方式包括：解剖型钢板、肱骨近端锁定钢板（locking plate of proximal humerus，LPHP）内固定及人工肩关节置换术。结果：所有病例均采用来院随访，按Neer百分法功能评定标准，手术组优良率81．8％（63／77），非手术组优良率85．4％（35／41）。结论：肱骨近端1、2型骨折，移位较小，可采用非手术治疗；对于3、4型骨折，采用解剖型钢板或LPHP内固定，术后外展支具固定，严重粉碎骨折采用人工关节置换术，早期被动后期主动功能锻炼，辅以中药治疗及理疗，可获满意效果。

An Analysis of Effect on the Proximal Humeral Fracture with Various Kinds of Management

Objective： To analyze the indications of surgical and non-surgical treatments of proximal humeral fracture （PHF） ,the selection of operations and the importance of rehabilitation after surgery. Methods：To retrospect 128 cases, 77 cases of all were surgically treated with anatomical plate,locking plate of proximal humerus（LPHP）and artificial shoulder joint, the others were non-surgically treated. Results：All cases were followed up. Score the shoulder function by Neer standard,63 cases of all 77 treated surgically is excellent, the excellent rate is 81.8% （63/77）. And in non-surgical treatment group, the excellent rate is 85.4% （35/41）. Conclusion： Non-surgical treatment is fit for the Ⅰ and Ⅱ types of PHF. Surgical treatment with plate or artificial joint to the Ⅲ and Ⅳ types of PHF assisted by active and passive exercise is reliable and satisfactory,with less complication,good fracture cure.