肱骨近端骨折的手术治疗

目的 讨论肱骨近端骨折的手术治疗方法。方法 2000年1月至2004年12月，手术治疗有移位的肱骨近端骨折127例，其中内固定手术114例，肱骨头置换手术13例。男48例，女79例，年龄2l至75岁，平均54岁。采用Neer分类，二部分骨折69例，（其中解剖颈骨折4例，外科颈骨折65例），三部分骨折47例，四部分骨折11例。所有二部分和45例三部分骨折分别行三叶草钢板或肱骨近端解剖钢板及肱骨近端锁定钢板（locking proximal hunerus plate，LPHP）内固定，而2例三部分和所有四部分骨折均行人工肱骨头置换术（humeral head replacement，HHR）。结果 术后随访4～48个月，平均17．1个月。内固定术后所有骨折均愈合，无畸形愈合。愈合时间为6～9周，平均7周。肱骨头置换术后，假体未出现松动、脱位等现象。所有病例均无感染、神经、血管损伤等并发症发生。根据美国Michael Reese医疗中心评分标准，内固定术或肱骨头置换术后肩关节功能评分，优良率分别为85％和70％。结论 对肱骨近端移位骨折采用手术治疗可取得较为满意的效果。二部分骨折及多数三部分骨折可采用钢板内固定，而四部分骨折可一期行关节置换术。

Operative treatment of proximal humeral fracture

Objective To introduce the methods and results of operative treatment of proximal humeral fractures. Methods From January 2000 to December 2004,127 cases suffered from displaced proximal humeral fractures were treated with operative methods.There were 48 males and 79 femalcs,average age of 54 years(21 to 75 years).Using Neer fracture classification system,there were 69 cases with two-part fracture,(among them,65 were surgical neck fractures and 4 were anatomical neck fractures),47 with three-part and 11 with four-part. According to different types,we adopted different operative methods including anatomical or trefoil shaped plates(83 cases),locking proximal humerus plate(LPHP)(31 cases)and humeral head replacement(HHR)(13 cases).With a slings given to patients postoperatively,active and passive motion of should joint was allowed two days affer operation. Results All the patients were followed up. The mean time of bone union was 7 weeks,there was no delayed,nonunion or malunion in all cases. No lessening prosthesis,prosthesis dislocation or nerve damage occurred. Accordion to Michael Reese medical center system,the function was good or excellent in 85% of plate group,70% of prosthesis group. Conclusion Surgical method is a sarisfactory and effective technique in the treatment of proximal humeral fracure. How to choice the treatmend depend on types of fractures and other individual condition.In two-part and most three-part fractures,open reduction and internal fixation is a preferable method. For four-part fractures,because of necrosis and other complication. We adopted HHR, help in keeping the function and relieving the pain of the shoulder postopertively.Early and active functional rehabilitation are closely related to the results.