肱骨近端骨折治疗方式的进展与思考

Progress and Thinking on the Treatment of Proximal Humeral Fracture

摘要: 目前在所有骨折发生机率中肱骨近端骨折占6%~9%，这通常发生在患者低能量跌倒后。虽然对85%的肱骨近端骨折开展非手术治疗可以达到患者能够接受的结果，但手术治疗通常在不稳定骨折中进行，特别是在骨质疏松和移位的病例中。另一方面，肱骨近端骨折的保守治疗通常会导致肩部残疾，这是由于肩峰下撞击以及外展和外旋的限制。受益于手术器械和技术的重大改进，更广泛的手术治疗适应症被认为是外科医生的一种选择。稳定的固定是手术目的，手术治疗也可以提供早期康复训练，恢复关节功能。因此，如今手术治疗越来越被认为是最常见的选择。现对肱骨近端骨折的治疗现状进行阐述。

Abstract: The incidence of comminuted fractures of the proximal humerus has increased in recent years due to osteoporosis in elderly patients. Complications such as nerve injury, soft tissue contusion, and rotator cuff tear make surgical treatment of these fractures difficult. Proximal humeral fractures cause loss of arm function and severe pain directly after trauma, and often lead to persistent disa-bility, prolonged recovery and recovery times. For the treatment of Neer’s proximal part humerus fracture, a variety of surgical treatments are used clinically. Among them, incision reduction and internal fixation with screws and plates, as well as artificial shoulder prosthesis replacement, are widely used around the world. Cut reduction and screw and plate fixation are effective in treating simple fractures of the proximal humerus with maximum bone mass preservation and minimal side effects on the shoulder joint. However, in patients with comminuted fractures of proximal humerus fractures, the rate of necrosis after traditional incision reduction and internal fixation or intrame-dullary nail therapy is higher than other techniques, and clinical outcomes are not good. In recent years, the technical improvement of artificial shoulder prosthesis has made humeral head re-placement used in the treatment of complex proximal humeral fractures and achieved satisfactory clinical results.