肱骨近端骨折107例手术治疗的临床体会.docVIP

肱骨近端骨折107例手术治疗的临床体会 【摘要】 目的 总结 肱骨近端骨折手术 治疗 的临床疗效、适应证及手术体会。方法 对107例有手术指征的肱骨近端骨折患者分别采用螺钉和三叶草钢板或肱骨近端锁定钢板治疗，比较两种手术方式的治疗效果。结果 锁定钢板治疗组的疗效明显优于三叶草钢板组，锁定钢板的优良率90%，三叶草钢板的优良率81%。结论 在治疗肱骨近端骨折时，应根据患者的年龄、骨的质量、骨折类型和部位而选择适当的术式。肱骨外科颈骨折可选用三叶草钢板，三、四部分骨折或肱骨头骨折采用锁定钢板较好。大、小结节骨折可选择螺丝钉固定或结合钢板固定。对于型骨折争取钢板内固定，期肱骨头坏死或明显影响肩关节功能的患者做关节置换手术。 【关键词】 肱骨近端骨折;三叶草钢板;螺钉;肱骨近端锁定钢板;内固定 　　[Abstract] Objective To summarize the clinical curative effect,adaptive sign and the surgical treatment clinical experiences.Methods Retrospectively analyzed the therapy of the proximal humeral fractures in 107 patients and compared the outcome of the proximal humeral fractures by the screw and cloverleaf plate or the locking proximal humerus plate.Results Therapeautic outcome of the locking proximal humerus plate were obviously better than the cloverleaf plate, the good rate were 90%,P0.05.Conclusion In the treatment of proximal humeral fractures , we should choose reasonable methods on the basis of the age,the quality of bone,the type of fracture and the position of the proximal humeral. We can select the cloverleaf plate for the surgical neck of humeral fracture, but for the three and four parts fractures or the head of humeral fractures,we should better choose the locking proximal humerus plate(LPHP). The large or small node of humeral fractures can be suited to the screw or link with plate internal fixation; we should try to fixate fractures with plate for the Ⅳ type of proximal humeral fractures firstly, the second stage -in the follow-up stage we should think over the shoulder displacement in the light of the necrosis of the humeral head and the serious influence of the shoulder function. 　　[Key words] proximal humeral fracture; cloverleaf plate; screw; locking proximal humerus plate; internal fixation 　　肱骨近端骨折是指肱骨外科颈以远1～2cm至肱骨头关节面的骨折，包括肱骨头、大结节、小结节、肱骨干近端等结构的骨折，以中老年多见，其发生率约占全身骨折的4%～6%[1],20%的肱骨近端骨折需要手术治疗，大约11%肱骨近端骨折是三或四部分骨折[2]。 　　本文总结本院自2005年1月—2010年1月采用螺钉和三叶草钢板或肱骨近端锁定钢板治疗肱骨近端骨折107例手术治疗体会，现分析报告如下。 　 　1 资料与方法