Aschauer Erwin, Resch Herbert, Hübner Clemens
Klinik für Unfallchirurgie, Landeskrankenhaus Bad Ischl, Osterreich.
Oper Orthop Traumatol. 2007 Aug;19(3):276-93. doi: 10.1007/s00064-007-1206-6.
Reduction and fixation of displaced fractures of the humeral head by percutaneous methods. Early functional postoperative management.
Simple subcapital fractures of the humerus, AO 11A2, A3. Multifragmentary fractures of the proximal humerus, AO 11B1, B2, C1, (C2).
Head split fractures. Fracture dislocations. Severe osteoporosis.
The head fragment, generally impacted in valgus, is lifted by means of an elevator inserted percutaneously. The head is brought into the correct position and fixed to the shaft with two crossed Kirschner wires. The Kirschner wires are clamped into a locking device attached to the lateral cortex of the humerus by one screw to prevent slippage. Displaced tubercles are also reduced percutaneously by the aid of small bone hooks and are stabilized by insertion of cannulated screws.
Shoulder bandage for 3 weeks. Depending on the stability achieved during operation gentle exercising can be commenced from the 1st postoperative day with the arm bandaged.
200 patients (78 men, 122 women) were followed up at least 2 years (24-81 months) postoperatively. The average age was 61.6 years (14-103 years). The average Constant Score for four-part fractures was 87%. 24% of the patients had to be operated on a second time (shortening of the wires or reosteosyntheses). In 8.5% secondary change of management was necessary. In 3% clinically relevant avascular head necrosis occurred, and pseudarthrosis in 3%.
采用经皮方法复位并固定肱骨头移位骨折。术后早期进行功能管理。
肱骨单纯头下型骨折，AO 11A2、A3。肱骨近端多段骨折，AO 11B1、B2、C1、（C2）。
头劈裂骨折。骨折脱位。严重骨质疏松。
通常呈外翻嵌插的头骨折块，通过经皮插入的骨膜剥离子抬起。将肱骨头复位至正确位置，并用两根交叉克氏针固定于骨干。克氏针通过一枚螺钉夹在附于肱骨外侧皮质的锁定装置中，以防止滑动。移位的结节也可借助小骨钩经皮复位，并通过插入空心螺钉进行固定。
肩部包扎3周。根据手术中获得的稳定性，术后第1天即可在包扎手臂的情况下开始轻柔锻炼。
200例患者（78例男性，122例女性）术后至少随访2年（24 - 81个月）。平均年龄61.6岁（14 - 103岁）。四部分骨折的平均Constant评分87%。24%的患者需二次手术（克氏针缩短或再次骨固定）。8.5%的患者需要进行二次治疗调整。3%的患者发生临床相关的缺血性股骨头坏死，3%的患者发生假关节。
