摘要目的总结治疗肱骨近端移位骨折的手术方法及结果。方法手术治疗肱骨近端骨折31例，男18例，女13例，平均年龄36．8岁，平均随访时间40．5个月；手术均采用三角肌胸大肌间隙入路，钢板固定12例，单纯螺钉固定15例，克氏针加石膏固定4例；采用Neer分类及评分方法评价手术效果。结果两部分外科颈骨折优良率为69％，无坏死及骨折不愈合；三部分骨折和四部分骨折切开复位内固定的满意率较低；三部分骨折的肱骨头坏死率为44％，四部分骨折坏死率达75％。结论两部分骨折和三部分骨折可采取切开复位内固定，但尽量避免使用钢板；对“经典”四部分骨折，内固定的满意率较低且坏死率较高。

abstractsObjective To study the methods and the results of operative treatment of displaced proximal humeral fractures． Methods We reviewed thirty-one patients who had been diagnosed as having displaced proximal humeral fractures and had been operated on from July 1989 to December． 1998 in our hospital． The mean follow-up time was 40．5 months (8-124 months)． Their age ranged from 15 to 62 years (average, 36．8 years); 18patients were male and 13 female． Neer fracture classification system and rating system were used． In all patients, delto-pectoral approach was adopted． Twelve fractures were fixed with plates, fifteen fractures with screws, and four fractures with Kirschner wire and plaster． Results Of two-part surgical neck fractures, nine of thirteen pa tients (69%) were excellent or good with no necrosis and nounion． In three-part or four-part fractures, the rate of satisfaction with open reduction and internal fixation (OR1F) was rather lower． In three-part fractures, the rate of humeral head necrosis was 44%, and in four-part fractures, over 75%． Conclusions In two-part and threepart fractures, ORIF is a better treatment, but care shoald be taken to avoid using plates． As for classic four-part fractures, the rate of satisfaction with ORIF is poor and the rate of necrosis is higher．