切开复位内固定治疗陈旧性肱骨近端骨折

The results of open reduction and internal fixation for delayed proximal humeral fractures

目的探讨采用切开复位内固定治疗陈旧性肱骨近端骨折的临床效果。方法2005年1月至2008年7月，采用肱骨近端锁定钢板治疗陈旧性肱骨近端骨折患者26例，男11例，女15例；年龄22-81岁，平均493岁；左侧16例，右侧10例。手术距受伤时间22-510d，平均88d。骨折类型：两部分外科颈骨折12例，两部分小结节骨折1例，两部分大结节骨折7例，三部分大结节骨折3例，四部分骨折2例（均非外展嵌插型骨折），头劈裂型骨折1例。其中6例患者合并其他部位骨折。应用ASES评分、Constant评分、UCLA评分以及SST问卷进行功能评分，并记录肩关节活动范围、疼痛程度，按不同性别、年龄、伤侧、手术次数、是否存在其他损伤进行多因素方差分析；对手术时间和结果进行相关分析；并对骨折类型、手术方式、是否出现并发症进行比较。结果26例患者随访时间为12-30个月，平均16．9个月。肩关节活动范围平均为：前屈上举137-3°±35．1°，外旋28．9°±24．1°，内旋达T10水平。VAS评分为（0．7±1．2）分；Constant评分为（83．1±17．9）分；UCLA评分为（28．9±6．0）分；SST为8．7个。不同性别组仅在内旋活动方面存在明显差异。不同年龄、伤侧、手术次数、手术时间、固定方式、骨折类型、是否出现并发症之间无统计学差异。结论陈旧性肱骨近端骨折在规范治疗的前提下，可以采用切开复位内固定进行治疗。

Objective To evaluate the results of delayed proximal humeral fractures treated by open reduction and internal fixation. Methods From January 2005 to July 2008, 26 patients with delayed proximal humeral fractures were treated by open reduction and internal fixation. There were 11 males and 15 females. The patients ranged from sixteen to 22-81 years old, with an average age of 49.3 years. The interval from injury to operation ranged 22 to 510 days, with a mean of 88 months. There were two-part fractue in surgical neck in 12 cases, two part in lesser tubercles of in one case,two part in greater tubercles in seven cases, three part in greater tubercles in three cases, four part in 2 cases and the splitting fracture in the head of humerus in one case.The range of motion, VAS for pain, ASES （American shoulder and elbow surgeon＇s form） score, Constant score, UCLA （University of California-Los Angels scoring system）score and SST（Simple Shoulder Test） for function evaluation were all recorded. The results were evaluated according to sex, age, injury side, operation times and combined injury by ANOVA.The correlation analysis was performed between operative time and results. Results The average forward flexion was 137.3°±35.1°, average external rotation was 2 8.9°±24.1° and internal rotation was T10- The mean VAS score was 0.7±1.2, the mean Constant was 83.1±17.9, the mean UCLA was 28.9±6.0, the mean SST was 8.7. There were no difference regarding sex, age, injury side, operation time and combined injury, fracture type and complications groups. No correlation existed between operative time and results. Conclusion It is very hard to treat delayed proximal humeral fracture due to high complication and demanding experience. With appropriate surgical technique, satisfactory results can be expected by open reduction and internal fixation.