摘要
目的探讨特殊类型肱骨近端骨折的处理策略,分析疗效,优化治疗方案。方法按照Neer的分型系统收集本院2005年1月～2010年8月的Ⅱ～Ⅵ型肱骨近端骨折45例,根据X线及CT扫描三维重建分型,结合患者的性别、年龄、职业、全身情况和骨质条件等综合判断,制定个性化的治疗方案并配合积极的康复治疗计划。用Neer百分制评分法评价疗效。结果所有病例均获得随访,随访时间8～34个月,功能评定采用Neer百分制评分标准:优32例、良10例、可2例、差1例,总优良率为93.3%,而锁定钢板固定的优良率达95%。结论对移位的、特别是伴有骨质疏松的肱骨近端骨折,保守治疗愈合及功能恢复多不理想,以往的内固定技术又很难达到坚强固定使肩关节能进行早期安全的功能锻炼。综合评价每一病例,制定个性化的治疗方案是收到良好效果的前提。AO肱骨近端锁定钢板的应用,对特殊类型肱骨近端骨折,尤其是在伴有骨质疏松骨折的手术治疗上显示出较大的优势,适时选择肩关节置换术对某些病例来说是较为合理的。
Objective To exlore the strategy and analyze the results of the treatment of special type proximal humerus fractures,and optimize the therapeutic schemes.Methods A total of 45 cases with proximal humeral fractures were selected from January 2005.1 to January 2010.8 According to the Neer classification,they belonged to typeⅡ,typeⅢor typeⅣ.Combining with the results of X-ray and CT tri-dimensional reestablishment,age,gender,occupation,patient＇s general physical condition,bone quality and other factors,the individualized therapy scheme was formulated with rehabilitation.Results The 45 patients were followed up for 8～34 months.According to the Neer scoring system,the excellent was 32 cases,the good was 10 cases,the better 2 and the poor was 1 case,the excellent and good rate was 93.3%.Conclusion For displaced or osteoporotic proximal humerus fractures,the conservative therapeutic effect usually isn＇t ideal,and the traditional kinds of internal fixation are too limited to meet rigid fixation and early exercises.The satisfactory result shouid be based on a comprehensive evaluation and a characteristic project of treatment.AO locking proximal humerus plate has advantages on special type proximal humerus fractures with special reference to osteoporosis,and it could be reasonable to choose shoulder replacement for some special patients at times.
出处
《当代医学》
2011年第20期73-75,共3页
Contemporary Medicine
关键词
肱骨近端骨折
特殊类型
策略
疗效
Proximal Humerus Fractures
Special Type
Strategy
Effect
