肱骨近端骨折【26页】.pptxVIP

肱骨近端骨折

Fracturesoftheproximalhumerus2021/4/271DepartmentofTraumaticOrthopedic

老年常见骨折（3rd)所有骨折4-6%男：女=1：2女性骨折风险随着年龄增加损伤机制：常伴有骨折脱位神经损伤低能量损伤：摔倒时手撑地（老年）高能量损伤（青壮年）肌肉收缩（电击、癫痫，运动损伤）Introduction2021/4/272DepartmentofTraumaticOrthopedic

460BC-Hippocrates第一次记载了牵引治疗肱骨近端骨折1869-Krocher肱骨近端骨折分型1934-Codman基于骺线将肱骨近端分为4部分1970-Neer分型OrthopaedicsHistory2021/4/273DepartmentofTraumaticOrthopedic

AnatomyAnatomy2021/4/274DepartmentofTraumaticOrthopedic

Anatomy颈干角130-135度后倾角35-40度大结节低于关节面最高点7-10mm2021/4/275DepartmentofTraumaticOrthopedic

Anatomy前面后面2021/4/276DepartmentofTraumaticOrthopedic

FromSchlegelTF,HawkinsRJ:Displacedproximalhumeralfractures:evaluationandtreatment,JAmAcadOrthopSurg2:54,1994.)肱骨近端的血供旋肱前动脉是肱骨头的主要供血动脉它的分支进入骨内称为弓形动脉，为整个肱骨头供血(Laing1956年）旋肱后动脉只供应关节面后下方的一小部分。通过肩袖附着点进入肱骨头的血管同样重要Blood-supply2021/4/277DepartmentofTraumaticOrthopedic

Neer分型按主要骨折块而非骨折线数目肱骨近端四个解剖部位：肱骨头、大结节、小结节、骨干或外科颈移位标准：移位超过1cm或成角超过45°FromNeerCSII:DisplacedproximalhumeralfracturesI:classificationandevaluation,JBoneJointSurg52A:1077,1970Classification2021/4/278DepartmentofTraumaticOrthopedic

Classification2021/4/279DepartmentofTraumaticOrthopedic

History局部肿胀、压痛骨檫感主被动活动受限患肢紧贴胸壁，用健侧手托住2021/4/2710DepartmentofTraumaticOrthopedic

ImagingCT2021/4/2711DepartmentofTraumaticOrthopedic

Treatment非手术疗法适应症非移位的或者轻度移位大结节骨折移位5mm部分移位的肱骨外科颈骨折2部分骨折有手术禁忌证的患者早期制动定期复查X光片并发症：关节僵硬骨不连创伤性关节炎2021/4/2712DepartmentofTraumaticOrthopedic

手术治疗适应症结节部骨折干部移位2/3成角45度3-4部分骨折2021/4/2713DepartmentofTraumaticOrthopedic

CRPP(闭合复位经皮穿针内固定术)微创手术骨质量好，轻度干骺端粉碎末端有螺纹的克氏针或真空心钉2-，3-和4-部分骨折儿童患者2021/4/2714DepartmentofTraumaticOrthopedic

IM(髓内钉）微创手术顺行髓内钉肩袖损伤逆行髓内钉只适用于2部分骨折应用不广泛2021/4/2715DepartmentofTraumaticOrthopedic

经骨缝合固定适应症骨质量差老年患者结果带线铆钉的使用2021/4/2716DepartmentofTraumaticOrthopedic

ORIF2021/4/2717DepartmentofTraumaticOrthopedic

即便是在严重骨质疏松情况下也能很好防止复位丢失锁