肱骨近端骨折的外科治疗及术后康复

Surgical treatment and postoperative rehabilitation of proximal humeral fracture

目的 探讨肱骨近端骨折的手术及非手术治疗适应证、手术治疗方法及手术对患肢功能恢复的重要性。 方法 1999年 1月～ 2 0 0 0年 12月 ,对收治的 4 6例肱骨近端骨折患者 ,依据Neer分型及骨折移位的严重程度进行非手术治疗 15例 ,手术治疗 31例 ,术后患肩早期外展支架固定及康复锻炼。 结果 本组患者均获随访 ,随访时间为 6～ 2 6个月 ,平均 12 .6个月。患肢功能按尚天裕等肩关节功能评估标准 ,手术组和非手术组的肩关节功能优良率分别为 93.5 % (2 9/ 31)和93.3% (14 / 15 )。 结论 肱骨上端骨折仅有较小的移位 ,一般用非手术治疗。对于复杂的肱骨近端骨折 ,采用T形钢板内固定手术治疗 ,同时配合外展支架固定及规范的功能锻炼可获得满意的疗效 ,降低了此处骨折凝肩及其他并发症的发生率。其治疗重点是可靠的固定及早期功能恢复。

Objective To study the indications of operation or non operation in proximal humeral fracture, therapeutic methods of operation, and the importance of operation in functional rehabilitation. Methods From January 1999 to December 2000, 46 cases of proximal humeral fractures were classified according to Neer's classification and severity of displacement degrees. Fifteen cases were treated by non operation methods and 31 cases were operated. Early external fixation and normal rehabilitation exercises after operation were encouraged. Results All the 46 cases were followed up. The follow up ranged from 6 26 months with an average of 12.6 months. The function of the injured extremity was evaluated according to Tianyu Shang's functional assessment standard of shoulder joint. The excellent rate of shoulder joint function was 93.5% in the operation group and 93.3% in the non operation group. Conclusions For complex proximal humeral fractures, internal fixation by using T plate plus abduction cage and normal functional exercises can obtain satisfactory therapeutic results and reduce the incidence of frozen shoulder of fracture area and other complications. Reliable fixation and early functional rehabilitation are important.