肱骨近端复杂骨折的治疗策略

The Treatment Strategy of the Complex Proximal Humerus Fractures

目的探讨肱骨近端复杂骨折的合理治疗策略,明确治疗方法和具体治疗手段。方法回顾总结32例肱骨近端复杂骨折病例资料。按Neer四部分骨折分类:一或二部分骨折8例采用保守治疗,18例〔三部分骨折14例(其中4例伴肩关节脱位并有3例合并臂丛神经损伤)、四部分骨折4例〕采用切开复位解剖型LC-DCP钢板内固定,6例(四部分骨折伴脱位)采用人工肱骨头假体置换术。结果32例均获随访,时间6～36个月,平均16个月。Constant FunctionalScore总体平均评分80.7分,总体优良率75%。无一例肱骨头坏死和关节脱位发生。结论对于肱骨近端复杂骨折只要根据骨折具体情况严格分型并选用合理治疗手段,术中充分保留肱骨头血供,有效修复肩袖和大小结节,坚强骨折内固定,尽早合理的关节功能锻炼,可以达到满意的治疗效果。

Objective To investigate the effective treatment strategy for the complex proximal humerus fractures, select the better and appropriate treatment method, Methods 32 cases of the complicated proximal humerus fractures were retrospectively summarized. Based on NEER system, 8 cases [One or Two-parts lesion）were treated by closed re- duction, 18 cases,which included 4 cases Four-parts lesion and 14 cases Three-parts lesion [4 cases were concomitant with irreducible shoulder dislocation and brachiplex injury） were reduced openly and fixed internally with anatomyshaped LC-DCP plate. 6 cases [Four-parts lesion be concomitant with irreducible shoulder dislocation） were treated with prosthetic humeral head replacement operation. Results 32 cases were followed-up at a mean time of 16 months （6 to 36）. According to Constant Functional Score system,excellent and good rate was 75%and population mean Score was 80. 7. Neither humeral head necrosis nor shoulder dislocation did happened post operation. Conclusion The key treatment for the complex proximal humerus fractures are selecting the best appropriate method;protecting the vascular supply of the humeral head ;repairing rotator cuff;strong fixation ;earlier exercise and physical treatment.