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切开复位内固定治疗严重嵌插外展型肱骨近端骨折

Open reduction and internal fixation for treatment of severely impacted valgus proximal humeral fractures

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目的 评价切开复位内固定治疗严重嵌插外展型肱骨近端骨折的临床效果.方法 004年4月-2008年2月,手术治疗严重嵌插外展型肱骨近端骨折23例,采用改良的Thompson切口切开复位,用肱骨近端锁定钢板固定,其中20例行一期自体骨移植,8例术中发现有明显的肩袖撕裂而行修补术.术后进行系统的肩关节功能锻炼.结果 23例获得1年以上的随访,平均随访时间为17个月(12~33个月).所有骨折均于术后2个月内愈合,最近一次X线片检查未出现内固定失效和肱骨头坏死.采用肩关节Neer评分系统评分:优9例,良10例,可3例,差1例;优良率为82.6%.患者主观满意率为91.3%.5例出现供骨区髂部疼痛.结论 采用切开复位LPHP内固定治疗严重嵌插外展型肱骨近端骨折有利于早期功能锻炼,疗效满意.

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Objective To assess the clinical results of open reduction and internal fixation(ORIF) for treatment of severely impacted valgus proximal humeral fractures. Methods From April 2004 to February 2008,twenty-three patients with a severely impacted valgus fractures of the proximal part of the humerus were treated with ORIF.The modified Thompson approach was employed to facilitate open reduction of the fractures and fixation with LPHP.Autologous bone graft was filled in the metaphyseal defect created behind the humeral head following its reduction in 20 cases.The rotator cuff tear was identified in 8 cases and was repaired with nonabsorbable sutures during the surgery.Systematic rehabilitation of the shoulder joint was performed postoperatively. Results All patients were followed up for at least one year,with an averaged of 17 months (ranged from 12 to 33 months).All fractures united within two years postoperatively.No patient had signs of internal fixation failure and avascular necrosis on the latest radiographys.The clinical outcomes were rated using Neer score system.Nine cases were graded as excellent,10 cases as good,3 cases as fair,and one as poor.The overall excellent and good rate was 82.6%.Patients' satisfactory rate was 91.3%.Pain at the iliac donor site was noted in 5 cases. Conclusion Treating severely impacted valgus proximal humeral fractures with open reduction and internal fixation using improved early motion of the shoulder and produced good clinical results.

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