肱骨近端骨折诊断、决策原则和治疗(中文在备注里)汇编.pptVIP

Hospital for Special Surgery protocol Nonoperative Tx Elderly Non-displaced or mod displaced Nonop tx surgery sling + ROM Journal of the American Academy of Orthopedic Surgeons Court-Brown et al., JBJS B , 2001 Jan 07 Treatment: Non-operative Koval et al., JBJS, 1997 77% good or excellent; 13% fair, 10% poor results Functional recovery averaged 94% Sling with ROM exercises by 2 weeks Treatment: Non-operative Court-Brown et al., JBJS B , 2001 Mean age 72 yrs Outcome determined by age and degree oftranslation Surgery did not improve outcomes regardlessof translation Hospital for Special Surgery protocol Poor bone quality Operative Tx heavy suture through rotator cuff insertion “significant displacement” 5mm GT 66% SN Locking plate Journal of the American Academy of Orthopedic Surgeons Jan 07 or Hospital for Special Surgery protocol Operative Tx Satisfactory bone quality Closed reduction percutaneous pins Journal of the American Academy of Orthopedic Surgeons Jan 07 Hospital for Special Surgery protocol Operative Tx Satisfactory bone quality ORIF Journal of the American Academy of Orthopedic Surgeons Jan 07 Hospital for Special Surgery protocol Nonoperative Tx B1.1 Poor bone quality Court-Brown, JBJS B , 2002 Zyto et al, JBJS B , 1997 Non-op surgery maybe better Journal of the American Academy of Orthopedic Surgeons Jan 07 Hospital for Special Surgery protocol ORIF High failure rates with standard plates Especially in patients with poor bone Locking plates have dramatically improved fixation Journal of the American Academy of Orthopedic Surgeons Jan 07 Hospital for Special Surgery protocol Hemiarthroplasty Highly displaced fxs “3 or 4-part” Poor bone quality Not reconstructable Journal of the American Academy of Orthopedic Surgeons Jan 07 Hemiarthroplasty 疼痛好转 良好的功能取决于解剖结节位置 虽然取得了这些进步,肩关节屈曲超过90o是很难实现的 * 解剖颈骨折缺血性坏死率高 + / - 50% ；除非能够恢复解剖,结构更好的来代替 半 * 决策过程的总结 * 保护功能是主要目标 解剖复位/尽可能多的保留软组织 坚强固定 半肩关节置换术仅用于不能重建截骨折 * 缓解疼痛主要目标；非手术治疗 如果骨折稳定和早期运动成为可能；骨折切开