中老年肱骨近端复杂骨折的手术治疗

Surgical Treatment for Complex Proximal Humeral Fracture in Middle and Old Patients

【目的】探讨肱骨近端复杂骨折手术治疗的方法及疗效。【方法】对47例肱骨近端复杂骨折患者随机采用锁定钢板固定25例，人工肱骨头置换22例，术后评估肩关节功能。【结果】术后随访6～43个月，平均18．5个月，按美国肩肘关节医师协会肩关节功能评估表评分，锁定钢板固定组优15例，良5例，可3例，差2例，优良率80．0％；肱骨头置换组优10例，良7例，可3例，差2例，优良率77．3％，两组疗效无显著性差异（P〉0．05）。【结论】对肱骨近端复杂骨折，根据患者的年龄、骨折类型，进行精细的手术操作，术后正确的功能训练，采取锁定钢板内固定或肱骨头置换均能取得较满意的疗效。

[Objeetive]To explore the surgical treatment methods and clinical effect of complex proximal humeral fracture. [Methods]Forty seven cases of complex proximal humeral fracture were randomly divided into 25 cases treated with locking proximal humeral plates and 22 cases with humeral head replacement. The shoulder joint function was evaluated after operation. [Results]All the cases were followed up for 6 - 43 months with the average of 18.5 months. According to shoulder joint function rating scale by American physician association of shoulder and elbow joint, in locking plate group, 15 cases were excellent, and 5 cases were good, and 3 cases were fair and 2 cases were poor, and the excellent and good rate was 80.0%. In humeral head replacement group, 10 cases were excellent, and 7 cases were good, and 3 cases were fair and 2 cases were poor, and the excellent and good rate was 77.3%. There was no significant difference in the efficacy between two groups（ P 〉0.05）. [Conclusion]According to the age of patients, the type of fractures, with careful and sophisticated operation skills and correct functional exercise after operation, both locking plate internal fixation and humeral head replacement can obtain relative satisfactory effects.