肱骨近端骨折的手术治疗

Surgical treatment of proximal humeral fracture

目的探讨肱骨近端二、三部份骨折的治疗方法.方法手术治疗肱骨外科颈骨折38例,按Neer分类标准分型:二部分骨折27例,三部分骨折11例.分3组:A组10例行普通T形钢板内固定;B组22例行三叶草钢板内固定;C组6例行克氏针或钢丝内固定.结果 27例获随访3～12个月.除1例陈旧性骨折延迟愈合外,其余均愈合,愈合时间3～12个月,无感染、内固定断裂等发生.根据Neer肩关节功能评分标准,T形钢板组平均81.2分,三叶草钢板固定组平均86.3分,克氏针固定组平均78.1分.结论明显移位的肱骨近端二、三部分骨折的治疗以钢板螺钉尤其是三叶草型钢板螺钉内固定,能提供更为坚强的固定,术后功能较好.

Objective To investigate the treatment of 2- and 3-part proximal humeral fracture. Methods 38 cases of humeral surgical neck fractures were treated surgically. According to Neer classification, there were 27 cases of 2- part fractures and 11 of 3-part. All cases were divided into 3 groups. Group A （ 10 cases） was treated with “T” plate, Group B （ 22 ） with cloverleaf plate and Group C （6） with K-wire or screws. Results 27 cases were followed up for 3 12 months. 26 cases got bony healing in 3 - 12 months and 1 old fracture got delayed union. No infection or instrument breakage was found. According to Neer shoulder function scoring system,it was 81.2 scores in Group A,86. 3 in Group B and 78. 1 in Group C. Conclusions The obvious displaced 2- and 3-part proximal humeral fracture should be treated with plate ,especially with cloverleaf plate, which can provide rigid fixation and restore better function.