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1、Treatment of Proximal Humerus Fractures肱骨近端骨折的治疗现状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. Goa
2、ls include an adequate reduction and stable fixation to initiate early motion and rehabilitation. Decision-making should be based on patient and injury specifics and surgeons experience. Various types of fixation, including plates, nails, or percutaneous pins, can maintain sufficient stability to pr
3、omote 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, com
4、minuted 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 l
5、ocking 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
6、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 p
7、late, Shoulder关键词：肱骨近端骨折，肱骨髓内钉，锁定钢板，肩关节INTRODUCTION介绍介绍Proximal humerus fractures occur in a dual distribution. Young people sustain these injuries in falls and high-energy accidents, whereas those older than 50 years old experience these fractures with increased incidence as they age.1,2 About thre
8、e fourths of proximal humerus fractures occur in individuals older than 60 years old, with an occurrence 3 times more often in women than in men.1,3 As the population ages and life-expectancy increases, the frequency of these injuries is rising. The majority of proximal humerus fractures are nondisp
9、laced or minimally displaced and stable. These are successfully treated nonoperatively with early rehabilitation. However, closed reductions of comminuted or severely displaced fractures are difficult to achieve and to maintain. Previous studies have reported less satisfactory results for 3- and 4-p
10、art fractures treated by closed reduction, with only as few as 10% of patients achieving satisfactory function.47 Consequently, displaced 3- and 4-part fractures in healthy, active individuals are now typically treated surgically to optimize shoulder function.肱骨近端骨折的发生存在双重分布。年轻人多发生于坠落及高能量损伤等情况下，而 50
11、 岁以上的老年人随着年龄的增高其发病率升高。四分之三的肱骨近端骨折发生在 60 岁以上的人，女性的发病率是男性的 3 倍。随着人口老龄化以及预期寿命的延长，这些损伤的发生率正在上升。大部分肱骨近端骨折为非移位性或移位较小的稳定骨折。这些可以通过非手术治疗和早期的康复治疗而成功治疗。然而，粉碎或严重移位的骨折闭合复位困难，并难于维持复位。以前的研究显示，闭合复位对于 3，4部分骨折而言很少能够获得满意的疗效，仅有 10的患者疗效满意。因此，目前对健康的、活动较多的患者多采用手术治疗以得到良好的肩关节功能。Historically there has been difficulty in esta
12、blishing guidelines for surgical treatment. Neer proposed that his classification system would improve clarity in understanding these injuries and in determining effective treatment.5,6 He noted particular difficulty with 3-part and 4-part fractures and sought to compare the results of various treat
13、ment modalities for this subgroup of patients.6 Many years later considerable controversy remains regarding the optimal strategy for these injuries; therefore, there is no consensus on the best management for patients with displaced proximal humerus fractures. Many techniques/fixation have been desc
14、ribed in the literature, with treatment options focused on the displaced fracture fragments because these may have limited vascularity and may benefit from reduction and fixation.历史上，对手术治疗指导的制定存在困难。Neer 提出，他的分型系统有助于进一步理解这些损伤，以及选择有效的治疗。他强调，对 3、4 部分骨折的处理尤其困难，并试图对比这些骨折亚型的各种治疗模式的疗效。多年以后，对这些损伤的治疗策略仍存在相当的
15、争议；因此，对肱骨近端移位骨折的最佳治疗方案仍然没有一致的意见。文献描述的大量的技术/固定方法，治疗的选择主要集中于移位的骨折段，因为其血运有限，并可能从复位中获益。OPERATIVE TREATMENT手术治疗手术治疗Despite general agreement that displaced or more complex fractures should be treated operatively, there is no consensus on the type of surgical fixation that should be used. Various methods,
16、 such as closed reduction and percutaneous pinning (CRPP), tension band wiring, intramedullary nailing, plate fixation, and hemiarthroplasty have all demonstrated mixed results. Fracture pattern, fracture displacement, bone quality, preexisting rotator cuff disease or arthrosis, and patient function are important factors to consider in developing a treatment plan. The primary goal should be a construct sufficiently stable to begin early range of motion of the shoulder.814 尽管普遍认为移位或更加复杂的骨折
