微创治疗肱骨近端骨折.docVIP

Treatment of Proximal Humerus Fractures肱骨近端骨折的治疗现状Summary: The majority of proximal humerus fractures are treated nonoperatively with good functional results. Multiple options exist for treating displaced fractures, without a clear advantage of anyone method for a given fracture type. Goals include an adequate reduction and stable fixation to initiate early motion and rehabilitation. Decision-making should be based on patient and injury specifics and surgeon’s experience. Various types of fixation, including plates, nails, or percutaneous pins, can maintain sufficient stability to promote shoulder mobility and function. Any of these methods will have few complications when undertaken with appropriate patient selection and careful surgical technique. Preliminary results of locking plates in the proximal humerus suggest that this is a favorable treatment option for displaced, comminuted proximal humerus fractures, which compares well with established methods. Locked plating may improve fracture stability in some complex patterns and facilitate early rehabilitation. It is possible that some fractures previously treated with hemiarthroplasty may be managed successfully with locking plates. Prospective study to assess the complications, outcomes, and cost effectiveness of nonoperative management compared to various surgical treatment options is warranted.大多数肱骨近端骨折采用非手术治疗常能获得良好的功能疗效。对移位骨折治疗存在多种治疗选择，对于某个特定的骨折而言，没有一种方法明显优越于另外一种方法。治疗目标包括充分的复位及稳定的固定以早期活动和康复。治疗决策的制定应该基于患者、损伤特点和外科医生的经验与喜好。不同类型的固定，包括钢板、髓内钉或经皮穿针，能保持骨折端的充分稳定以促进肩关节的活动和功能。当选择合适的病例和进行精心的外科治疗，这些方法很少发生并发症。早期疗效显示，肱骨近端锁定钢板是治疗移位粉碎肱骨近端骨折的一个较好的方法，与其他治疗方法相比疗效满意。在一些复杂病例中，锁定钢板能改善骨折的稳定性，有利于早期的术后康复。一些以前需要行半关节置换的骨折可能通过锁定钢板成功治愈。应当进行非手术疗法和各种手术疗法的关于并发症、疗效和花费－疗效比的前瞻性研究。KeyWords: proximal humerus fracture, humerus nail, locking plate, Shoulder关键词：肱骨近端骨折，肱骨髓内钉，锁定钢板，肩关节 INTRODUCTION介绍Proximal humerus fractures occur in a dual distribution. Young people sustain these injuries in falls and high-energy accidents, whereas those old