Sonderegger J, Simmen H-P
Chirurgische Abteilung, Spital Oberengadin, Samedan.
Zentralbl Chir. 2003 Feb;128(2):119-24. doi: 10.1055/s-2003-37765.
The epidemiology, therapy and results of proximal humeral fractures in a touristic area were investigated and our concept for treatment presented.
Between 1.1.1999 and 30.04.2000 adult patients with proximal humeral fractures were included, the fractures classified (Codman/Neer and AO) and results determined after an average of 9 months.
62 adults were treated. 59 (95 %) had an accident during leisure time, mainly skiing accidents (52 %). 7 patients (11 %) had an associated luxation of the shoulder. 51 (82 %) were treated conservatively, 11 (18 %) operatively with a T-plate. The conservatively treated had to wear a Gilchrist-cast for an average of 29 (operatively 13) days, started passive movement after 20 (operatively 9) days, and active movement after 44 (operatively 45) days. The 32 employed (52 %) were not able to work for 46 days on average. Overall, 52 patients (84 %) were totally or mostly satisfied with the result. 5 among the 13 patients (38.5 %) with 3- or 4-part-fractures, and 4 among the 11 operated patients (36.4 %) were not satisfied with the result.
Proximal humeral fractures are common skiing injuries, they need a long and intensive treatment and are economically expensive. The Codman/Neer and AO-classifications are equal. The results for simple, mainly conservatively treated fractures (Codman/Neer 1, 2A, 2-part) are good. Complex, mainly operatively treated fractures (Codman/Neer 3- and 4-part) have a much poorer prognosis. Diagnostically the computed tomography with 3-D-reconstruction is recommended for a better representation of the fracture and a safer choice of the therapeutical strategy.
对旅游区肱骨近端骨折的流行病学、治疗方法及结果进行调查，并介绍我们的治疗理念。
纳入1999年1月1日至2000年4月30日期间的成年肱骨近端骨折患者，对骨折进行分类（Codman/Neer和AO分类法），并在平均9个月后确定治疗结果。
共治疗62例成人患者。59例（95%）在休闲时间发生意外，主要是滑雪事故（52%）。7例患者（11%）合并肩关节脱位。51例（82%）接受保守治疗，11例（18%）采用T型钢板手术治疗。保守治疗的患者平均需佩戴Gilchrist石膏29天（手术治疗为13天），20天后（手术治疗为9天）开始被动活动，44天后（手术治疗为45天）开始主动活动。32名就业患者（52%）平均46天无法工作。总体而言，52例患者（84%）对治疗结果完全或基本满意。13例三部分或四部分骨折患者中有5例（38.5%）、11例手术患者中有4例（36.4%）对治疗结果不满意。
肱骨近端骨折是常见的滑雪损伤，需要长期、强化治疗，且经济成本高。Codman/Neer和AO分类法效果相当。简单骨折（主要采用保守治疗，Codman/Neer 1、2A、两部分骨折）的治疗效果良好。复杂骨折（主要采用手术治疗，Codman/Neer三部分和四部分骨折）的预后则差得多。诊断时，建议采用三维重建计算机断层扫描，以便更好地显示骨折情况，更安全地选择治疗策略。
