手术与非手术治疗肱骨近端骨折临床分析  

The Operative Treatment and Non-operation of Proximal Humeral Tracture

作　　者：范湧[1] 竺湘江 王刚祥[1] 宋南炎 赵勇[1] 李建波[1] 

机构地区：[1]嵊州市人民医院,浙江嵊州312400

出　　处：《浙江中医药大学学报》2012年第6期675-676,共2页Journal of Zhejiang Chinese Medical University

摘　　要：[目的]分析肱骨近端骨折手术与非手术治疗方法的疗效。[方法]2008年1月至2011年8月对57例肱骨近端骨折分别采用切开克氏针与螺钉、解剖钢板、锁定钢板及手法复位夹板固定治疗,所有患者随访11～28个月,平均19月,采用Neer评分方法评定疗效。[结果]采用手术方法和非手术治疗Ⅱ型骨折的优良率分别是87.5%和81.8%,两者疗效无显著性差异;采用手术方法和非手术治疗Ⅲ型骨折的优良率分别是82.4%和44.4%,两者疗效有显著性差异;切复内固定和切开行人工肩关节置换治疗Ⅳ型骨折的优良率分别是85.7%和80.01%,两者无显著性差异。[结论]对Ⅰ型和Ⅱ型骨折无明显移位者尽量采用非手术治疗,而Ⅲ型和Ⅳ型宜采用手术方法治疗,具体选择近端解剖钢板还是关节置换,需结合患者全身状况合理评估。[Objective] To analyse the clinical efficacy of operative treatment and non-operative treatment of proximal humeral fracture.[Methods] From 2008 to 2011,57 patients underwent the treatment of Kirschner’s wire,atomical plate,locking compression plate and close,reduction and splinter fixation,respectively.41 cases were male,16 cases were female.Age of patients averaged 49 years old（range,23～72 years old）.According to Neer classification,there were 19 cases of type Ⅱ,26 cases of type Ⅲ,12 case of type Ⅳ.[Result] All patients were followed up ranging from 11 months to 25 months（averaged 13.5 months）.8 patients of type Ⅱunderwent the operative treatment.6 cases were excellent,1 case was good,and 1 case was acceptable after the operation.The rate of excellent and good was 87.5%.11 patients of type Ⅱunderwent the non-operative treatment,7 cases were excellent,2 cases were good,2 cases were acceptable and none was bad.The rate of excellent and good was 81.8%,17 cases of type Ⅲ underwent the operative treatment,4 cases were excellent,2 cases were good,1 case was acceptable,and none was bad after the operation.The rate of excellent and good was 82.4%.9 cases of type Ⅲ underwent the non-operative treatment,none was excellent,6 case were good,3 cases were acceptable,and none was bad.The rate of excellent and good was 44.4%,7 cases of type Ⅳ underwent the anthroplasty of shoulder joint,3 cases were excellent,1 case was good and 1 case was acceptable.The rate of excellent and good was 80.01%.The clinical efficacy was acceptable.The operative efficacy of type Ⅱ of the fracture was almost the same as that of non-operative treatment.The operative efficacy of neer type Ⅲ was better than that of non-operative treatment.The efficacy of the open reduction and intern fixation of neer Ⅳ was as same as that of a troplasty.[Conclusion] The patients of type Ⅰ and type Ⅱ had better non-operative treatment.The patients of type Ⅲ and type Ⅳ had undergone the operative treatment by the firm fixation o

关 键 词：肱骨近端 骨折 内固定 肩关节置换 

分 类 号：R681[医药卫生—骨科学]