肱骨近端粉碎性骨折的手术治疗  

Surgical techniques for proximal humeral fracture

作　　者：周富根[1] 蒋国华[1] 费自威 柴益民[2] 曹武[1] 李明[1] 孙广臣[1] 吴继恒 鲍欢[1] 

机构地区：[1]嘉善县第一人民医院骨科,浙江嘉善314100 [2]上海交通大学附属上海市第六人民医院骨科,上海200233

出　　处：《临床骨科杂志》2011年第6期669-670,673,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨肱骨近端粉碎性骨折的手术方法选择及临床治疗效果。方法手术治疗39例肱骨近端移位粉碎性骨折患者,采用三叶草钢板内固定15例,AO锁定接骨板内固定22例,半肩关节置换2例。结果 39例均获随访,时间5～34个月。采用Constant-Murley绝对值评分法评估为58～97分,其中优12例,良16例,可7例,差4例,优良率为71%。患肩主动前屈上举活动度80°～180°(146°±34°),外展75°～180°(138°±42°),内旋40°～90°(52.8°±23.8°),外旋40°～90°(41°±19°)。结论决定治疗方法的四个最基本因素是年龄、骨质量、骨折类型以及手术方式。合理的手术方案结合系统化的康复训练,可获得良好的效果。Objective To analyze the relationship between the surgical strategy and the clinic result in different proximal humeral fractures.Methods 39 cases with proximal humeral fractures and/or should joint dislocation were enrolled.There were 15 cases were treated with blade plate,22 with proximal humeral locking plate(LPHP) and 2 cases with hemiarthroplasty.Results All 39 patients received a mean 16 months′ follow-up(from 5 to 34 months).Constant-Murley score was used to evaluate the final result,and the mean score was 58~97,among which there were excellent in 12,good in 16,fair in 7,and poor in 4,and the excellent and good rate was 71%.In the series mean range of extension was 146°±34°(from 80°to 180°),abduction 138°±42°(from 75°to 180°),internal rotation 52.8°±23.8°(from 40°to 90°),external rotation 41°±19°(from 40°to 90°).Conclusions The surgical strategy is base on four factors: age,bone quality,fracture type and the time of surgery.A well planed surgery combined with systemic rehabilitation would give a better result.

关 键 词：肱骨近端骨折 骨折 粉碎性 骨折固定术 内 三叶草钢板 肱骨近端锁定钢板 肱骨头置换 

分 类 号：R68[医药卫生—骨科学]