目的探討鎖定鋼板治療Neer三部分及四部分肱骨近端骨折的療效。 方法回顧分析2008年7月－2011年5月，采用切開(kāi)復(fù)位、鎖定鋼板內(nèi)固定治療并獲12個(gè)月以上隨訪的77例Neer三部分及四部分肱骨近端骨折患者的臨床資料。男39例，女38例；年齡18～81歲，平均54.2歲。致傷原因：跌傷47例，交通事故傷16例，高處墜落傷4 例，運(yùn)動(dòng)傷5例，其他原因5例。受傷至手術(shù)時(shí)間2～16 d，平均4.5 d。骨折根據(jù)Neer分型標(biāo)準(zhǔn)：三部分骨折54例，四部分骨折23例。隨訪評(píng)估患者肩關(guān)節(jié)功能Constant評(píng)分、疼痛視覺(jué)模擬評(píng)分（VAS）及相關(guān)并發(fā)癥。 結(jié)果術(shù)后76例切口Ⅰ期愈合，1例Ⅱ期愈合。患者均獲隨訪，隨訪時(shí)間12～36個(gè)月，平均18.5個(gè)月。末次隨訪時(shí)，Constant評(píng)分為（71.1 ± 11.9）分；獲優(yōu)18例，良24例，中25例，差10例，優(yōu)良率為54.5%。VAS評(píng)分為（2.8 ± 2.2）分。2例患者發(fā)生骨不連；余患者骨折均愈合，愈合時(shí)間2～6個(gè)月，平均3.2個(gè)月。術(shù)后25例患者發(fā)生并發(fā)癥，發(fā)生率為32.5%；15例行二次手術(shù)，二次手術(shù)率為19.5%。 結(jié)論對(duì)于Neer三部分及四部分肱骨近端骨折應(yīng)爭(zhēng)取解剖復(fù)位、穩(wěn)定固定、減少肱骨頭血供破壞，以獲得良好療效。
引用本文： 曾浪清,陳云豐,王磊,陸葉,張聞,陳強(qiáng),劉燕潔,章偉. 鎖定鋼板治療Neer三部分及四部分肱骨近端骨折療效. 中國(guó)修復(fù)重建外科雜志, 2012, 26(12): 1469-1472. doi: 復(fù)制
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| 5. | Solberg BD, Moon CN, Franco DP, et al. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg (Am), 2009, 91(7): 1689-1697. |
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| 8. | Tingart MJ, Lehtinen J, Zurakowski D, et al. Proximal humeral fractures: regional differences in bone mineral density of the humeral head affect the fixation strength of cancellous screws. J Shoulder Elbow Surg, 2006, 15(5): 620-624. |
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| 11. | Clavert P, Adam P, Bevort A, et al. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg, 2010, 19(4): 489-494. |
| 12. | 姜保國(guó), 張殿英, 付中國(guó), 等. 肱骨近端骨折的治療建議. 中華創(chuàng)傷骨科雜志, 2011, 13(1): 55-59. |
| 13. | Hepp P, Theopold J, Voigt C, et al. The surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome. J Shoulder Elbow Surg, 2008, 17(1): 21-28. |
| 14. | Chen YF, Zhu NF, Zhang CQ, et al. The relevance of the anatomical basis of fracture for the subsequent treatment of the anterior humeral circumflex artery and the axillary nerve. Int Orthop, 2012, 36(4): 783-787. |
- 1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury, 2006, 37(8): 691-697.
- 2. Sproul RC, Iyengar JJ, Devcic Z, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury, 2011, 42(4): 408-413.
- 3. Gardner MJ, Weil Y, Barker JU, et al. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma, 2007, 21(3): 185-191.
- 4. Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury, 2011, 42(11): 1283-1288.
- 5. Solberg BD, Moon CN, Franco DP, et al. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg (Am), 2009, 91(7): 1689-1697.
- 6. Russo R, Visconti V, Lombardi LV, et al. Da Vinci System: clinical experience with complex proximal humerus fractures. Musculoskelet Surg, 2010, 94 Suppl 1: S57-64.
- 7. 朱乃鋒, 陳云豐. 肱骨近端骨折內(nèi)固定物穩(wěn)定性的生物力學(xué)分析. 中國(guó)修復(fù)重建外科雜志, 2010, 24(12): 1459-1462.
- 8. Tingart MJ, Lehtinen J, Zurakowski D, et al. Proximal humeral fractures: regional differences in bone mineral density of the humeral head affect the fixation strength of cancellous screws. J Shoulder Elbow Surg, 2006, 15(5): 620-624.
- 9. Zhang L, Zheng J, Wang W, et al. The clinical benefit of medial support screws in locking plating of proximal humerus fractures: a prospective randomized study. Int Orthop, 2011, 35(11): 1655-1661.
- 10. Hettrich CM, Neviaser A, Beamer BS, et al. Locked plating of the proximal humerus using an endosteal implant. J Orthop Trauma, 2012, 26(4): 212-215.
- 11. Clavert P, Adam P, Bevort A, et al. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg, 2010, 19(4): 489-494.
- 12. 姜保國(guó), 張殿英, 付中國(guó), 等. 肱骨近端骨折的治療建議. 中華創(chuàng)傷骨科雜志, 2011, 13(1): 55-59.
- 13. Hepp P, Theopold J, Voigt C, et al. The surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome. J Shoulder Elbow Surg, 2008, 17(1): 21-28.
- 14. Chen YF, Zhu NF, Zhang CQ, et al. The relevance of the anatomical basis of fracture for the subsequent treatment of the anterior humeral circumflex artery and the axillary nerve. Int Orthop, 2012, 36(4): 783-787.