肱骨近端四部分骨折治疗方式的探讨

Treatment of 4-part proximal humeral fracture

目的 探讨肱骨近端四部分骨折的治疗方法及其临床疗效。方法 肱骨近端四部分骨折11例，术中关节面无法良好复位，行人工肱骨头假体置换6例；复位内固定5例。结果 11例均获随访，时间1—5年。6例行人工肱骨头置换者均无明显疼痛，肩关节活动度〉90％者5例、80％-90％者1例。X线片示假体位置均较好，无感染、松动、关节不稳等并发症发生。5例复位内固定者中，2例肱骨头坏死，明显疼痛，肩关节活度在20％左右；3例肱骨头无坏死，骨折愈合，肩关节活动度在40％-50％。结论 早期行人工肩关节置换治疗肱骨近端四部分骨折，术后肩关节功能恢复满意，是一种有效的治疗方法。复位内固定预后欠佳。

Objective To investigate the treatment of 4-part proximal humeral fracture. Methods 11 cases with 4- part proximal humeral fractures were enrolled, in which good reduction could not be achieved. 6 were undergone semiarthroplasty, and 5 were treated with open reduction and internal fixation. Results 11 cases were followed up for 1 - 5 years. In 6 cases undergone semiarthroplasty, no shoulder pain was complained; the shoulder rang of motion recovered to 90% in 5 cases, and 80% - 90% in 1. No malposition, infection, looseness or instability was found. In 5 cases with open reduction and internal fixation, 2 were founded humeral head necrosis with fairly pain and the shoulder rang of motion recovered to 20% ; 3 got bony healing without humeral head necrosis, and the shoulder rang of motion recovered to 40% - 50%. Conclusions It is effective to treat 4-part proximal humeral fracture with early semiarthroplasty, which can provide good function recovery. The prognosis of internal fixation is not as good.