切开复位内固定治疗肱骨近端三、四部分骨折

目的 观察切开复位内固定治疗肱骨近端三、四部分骨折的疗效。方法 37例肱骨近端三、四部分骨折采用切开复位内固定治疗。内固定方法包括AOT形钢板21例、Neer双张力带钢丝9例、AOT形钢板 Neer双张力带钢丝7例。术后按美国肩肘关节医师学会的肩关节评分系统进行疗效评估。结果 术后患肩基本无痛或轻微疼痛。比较健侧肩关节功能评分,患肩平均上举幅度恢复至健侧的75.35％,内旋恢复至71.38％,外旋恢复至70.79％,完成7项日常生活动作能力恢复至健侧的83.48％。显示总体疗效良好。结论 AOT型钢板适用于骨质条件好,肱骨头关节端骨块骨量多,肱骨大、小结节骨片较大,肱骨干骺端较粉碎的患者。反之则以Neer双张力带钢丝为佳。对骨质疏松,肱骨头关节端骨块骨量少,肱骨干骺端粉碎伴骨缺损患者,干骺端结构性植骨后,则联合使用两方法。

Open reduction and internal fixation for three-part and four-part proximal humeral fractures

Objective To observe the results of treatment for three - part and four - part proximal humeral fractures with open reduction and internal fixation. Methods 37 three-part and four - part proximal humeral fractures were treated by open reduction and internal fixation. The techniques of internal fixation included AO T buttress plates for 21 cases, Neer's double tension band wires for 9 and T buttress plates combined with double tension band wires for 7 cases. The postoperative results were evaluated by the rating system developed by American Society of Shoulder and Elbow Surgeons. Results All affected shoulders were no pain or remained mild pain post - operatively. 2 shoulders fixed with AO T buttress plates suffered from acromion impingement syndrome. 1 patient with double tension band wires had inferior subluxation of the glenohumeral joint. Comparing with the function of the opposite normal sides, the average range of motion of elevation in affected shoulders restored to 75.35% of the normal sides' level, internal rotation to 71.38% , external rotation to 70.79% and the abilities of performing 7 daily activities to 83.48 % . In general, the results were satisfatory. Conclusion To the patient who has good bone quality, more bone stock in humeral head fragment and tuberosities, it is adequate to use AO T buttress plate. Otherwise, double tension band wires is suitable. AO T buttress plate combined with double tension band wires , following structural bone graft for bone loss of humeral metaphysesis, a better choice for patients with severe osteoporosis, less bone stock in humeral head fragments and tuberosities and comminuted fractures with bone loss in humeral metaphyses.