肱骨近端严重粉碎性骨折脱位的外科治疗

Surgical treatment of severe comminuted fracture of the proximal humerus

目的 探讨肱骨近端严重粉碎性骨折脱位的临床特点及外科治疗方法。方法 对 1 2例严重的肱骨近端粉碎性骨折伴有肱骨头脱位的病例均行手术治疗。切开复位后分别选用T型钢板、L型钢板、改良分叶状钢板及自行研制的梯形钢板固定 ,7例取自体髂骨做肱骨头颈部骨缺损处填塞植骨术 ,术中同时修复撕裂的肩袖及关节囊。术后及早功能锻炼。结果 1 1例随访时间 4个月～ 8年 ,平均3年 7个月。疗效评定标准结合Neer评定法综合评估 ,优良率达 81 8%。结论 严重的肱骨近端粉碎性骨折伴肱骨头脱位 ,骨折块多且常累及肱骨头关节面 ,易造成肱骨头血供受损 ,常伴有肩袖及关节囊不同程度的撕裂。对该类骨折宜早期手术 ,采用有效、简便的内固定物 ,对破裂受损的关节囊及肩袖进行修补。

Objective To investigate the clinical features and surgical treatment of the severe comminuted fracture of the proximal humerus Methods 12 cases of the severe comminuted fracture of the proximal humerus were reduced openly and fixed internally with T shaped plate,L shaped plate,modified cloverleaf plate and the trapezoid shaped plate.The lacerated rotator cuff and capsule were repaired at the same time.Early rehabilitation was done after surgery.Results 11 cases were followed up from 4 months to 8 years.4 cases were excellent,5 cases were good and 2 cases were fair according to Neer evaluation.Excellent and good rate was 81 8%.Conclusion Complex and displaced fractures of the proximal humerus often results in the damage to the vascular supply of the humeral head and usually combined with the injury of the rotator cuff and capsule.Early operation and effective fixation should be used for such the fracture.Injured rotator cuff and capsule should be repaired.