Resch H
Landesklinik für Unfallchirurgie und Sporttraumatologie, Salzburg, Germany.
Unfallchirurg. 2003 Aug;106(8):602-17. doi: 10.1007/s00113-003-0661-2.
Fractures of the humeral head are very common in elderly people, with 70% of all such fractures being seen at an age of more than 60 years. For the radiological examination of the fracture, x-rays from two levels are mandatory. The number and position of the fragments, assessment of intact or ruptured periosteum between the fragments and muscle forces acting on the fragments have to be determined from the x-rays. A 3-D CT scan can be very useful for better understanding of the character of the fracture. The remaining displacement between fragments after reduction have to be evaluated according to their location. Even small incongruities between fragments in the subacromial space will impair the gliding mechanism, whereas remaining displacements between the head and shaft can be accepted to a much larger extent. According to the fracture mechanism, we can basically differentiate between avulsion fractures and depression fractures. The avulsion fractures are characterised by a varus tendency of the humeral head,whereas the depression fractures are characterised by a valgus position of the head fragment. This has to be taken into consideration when choosing the implant for fixation. The indication for reconstructive surgery or prosthetic replacement depends on the type of fracture, on the quality of bone and on the familiarity of the surgeon with the treatment of humeral head fractures. The implants currently used for fixation can basically be differentiated between rigid and semi-rigid. The indication for the one or the other depends on the fracture type and the bone quality. In general, for simple fractures and in case of poor bone quality semi-rigid implants are indicated. Despite the fact that an understanding of the character of the fractures and implants has improved over the last few years, there are still types of fractures which need primary prosthetic replacement.
肱骨头骨折在老年人中非常常见，所有此类骨折中有70%发生在60岁以上的人群。对于骨折的放射学检查，必须进行两个层面的X线检查。必须从X线片中确定骨折碎片的数量和位置、碎片之间骨膜完整或破裂的评估以及作用于碎片的肌肉力量。三维CT扫描对于更好地了解骨折特征非常有用。复位后碎片之间的剩余移位必须根据其位置进行评估。即使肩峰下间隙中碎片之间存在很小的不匹配也会损害滑动机制，而头部与骨干之间的剩余移位在更大程度上是可以接受的。根据骨折机制，我们基本上可以区分撕脱骨折和压缩骨折。撕脱骨折的特征是肱骨头有内翻倾向，而压缩骨折的特征是头部碎片处于外翻位置。在选择固定植入物时必须考虑到这一点。重建手术或假体置换的适应症取决于骨折类型、骨质以及外科医生对肱骨头骨折治疗的熟悉程度。目前用于固定的植入物基本上可以分为刚性和半刚性两类。选择哪一种取决于骨折类型和骨质。一般来说，对于简单骨折以及骨质较差的情况，建议使用半刚性植入物。尽管在过去几年中对骨折和植入物特征的理解有所提高，但仍有一些骨折类型需要一期假体置换。
