肱骨近端骨折43例的外科治疗体会

The experience of surgical treatment on proximal humeral fractures in 43 patients

目的探讨不同手术方法在不同类型肱骨近端骨折患者中的临床疗效。方法对2006年1月~2009年12月在该院治疗且获得随访的43例肱骨近端患者资料回顾性分析,其中男25例,女18例;年龄34~86岁,平均45.8岁。骨折根据NEER分型：二部分骨折16例,三部分骨折21例,四部分骨折6例;其中合并肩关节脱位5例。方法采用闭合或开放复位及交叉克氏针内固定6例,解剖型钢板内固定17例,锁定钢板内固定18例,人工肱骨头置换2例。结果 43例患者均获得随访,随访时间3~20月（平均11.6月）;克氏针内固定患者均骨愈合,但有4枚克氏针滑出;解剖型钢板内固定患者16例骨愈合,近端松质骨螺丝钉松动7根,1例出现肱骨头坏死吸收;锁定钢板内固定18例患者均一期骨愈合,尚未发现明显并发症;人工肱骨头置换2例患者肩关节功能恢复尚可。按NEER评分系统：优24例,良13,可5例,差1例。结论肱骨近端骨折不能一概而论用某种内固定适合,根据患者年龄和不同类型选择不同方法固定或人工关节置换方能取得满意疗效。

Aim To discuss the therapeutic effect of several different surgical treatments on the patients with different types of proximal humeral fractures.Methods Among 43 cases of patients,6 cases were classified by close or open restore and internal fixation with Kirschner wire fixation of cross,17 cases were classified by internal fixation with dissection plate,18 cases were classified by locking plate fixation,2 cases were classified by humeral head replacement.Results Forty-three cases were followed up for 3 to 20 months（average 11.6 months）.Kirschner wire fixation group were bone healing,but four Kirschner wires were slided.Sixteen cases were bone healing among anatomic plate fixation group,and there were 7 proximal cancellous bone screws loose,and 1 case was of humeral head necrosis absorption.All 18 cases in locking plate fixation group were bone healing one stage.No significant complications were found among them.The shoulder joint function of two cases of humeral head replacement had restored a little artificial humeral head replacement in 2 cases of shoulder function can still be.According to NEER rating system we can reach a conclusion in this treatment： 24 cases were excellent,13 cases were good,5 cases were somewhat satisfied and 1 case was bad.Conclusion We can not only use some internal fixation to treat proximal humeral fractures mechanically or doctrinally,conversely we should choose several different internal fixation or replacement according to patients＇ different ages and their different types of proximal humeral fractures to obtain satisfactory results.