肱骨近端复杂骨折的手术选择  

The choice of operative methods for complicated proximal humeral fractures

作　　者：徐卿荣[1] 董英海[1] 王伟力[1] 陈滨[1] 

机构地区：[1]上海第二医科大学附属仁济医院骨科,上海200127

出　　处：《临床骨科杂志》2005年第5期413-415,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨肱骨近端复杂骨折的手术选择。方法肱骨近端复杂骨折61例,分为3组。A组23例,为肱骨近端二、三部分骨折,行闭合复位经皮穿针内固定。B组15例,为肱骨近端三、四部分骨折,行切开复位锁定钢板内固定。C组23例,为肱骨近端三、四部分骨折,行人工肱骨头置换术。结果3组随访6～36个月。A组和B组用Neer百分制评分表对患肩进行术后功能评估,C组用ASES评分对患肩进行术后功能评估。A组和B组骨折均愈合,无骨折再移位、肱骨头无菌性坏死病例。A组优良19例,疗效欠佳的病例均为三部分骨折。B组优良12例,疗效欠佳的病例均为四部分骨折伴骨质疏松。C组优良20例。结论每一种手术方法都有其优点和缺陷,骨折的类型、大小、移位程度、患者年龄、骨质量以及手术医师的操作技能等因素决定了治疗方式。Objective To investigate the choice of operative methods for the complicated proximal humeral fractures. Methods 61 complicated proximal humeral fractures were divided into 3 groups. Group A （23 two- and three-part proximal humeral fractures） was treated with closed reduction and percutaneous fixation with Kirschner wire. Group B （15 three- and four-part proximal humeral fractures） was treated with open reduction and internal fixation with locking proximal humeral plate. Group C （23 three- and four-part proximal humeral fractures） was treated with shoulder hemiarthroplasty. Results 3 groups were followed up for 6 - 36 months. Clinical outcomes of group A and B were evaluated by Neer Rating System, and that of group C by ASES Score. All fractures of group A and B healed without redisplacement and avascular necrosis. In group A, B and C, 19, 12 and 20 fractures presented excellent or good resuits, respectively. Poor results were found in group A with three-part fracture and in group B with osteoporotic fourpart fracture. Conclusions Each operative method has its merits and demerits. The method is determined by the type, severity and displacement of fracture, the age of patient, the quality of bone and the skill of surgeon.

关 键 词：肱骨骨折 骨折固定术 内 

分 类 号：R683.41[医药卫生—骨科学] R687.3[医药卫生—外科学]