Zhu Yi-Ming, Jiang Chun-Yan, Lu Yi, Wang Man-Yi
Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China.
Zhonghua Wai Ke Za Zhi. 2007 Oct 15;45(20):1385-8.
To investigate the results of two-part surgical neck fractures of proximal humerus treated with locking intramedullary nail for proximal humerus, and to discuss the indication, surgical technique and the effectiveness.
The data of the 22 patients with two-part surgical neck fractures fixed with proximal humeral nail was retrospectively reviewed. The mean age was 57 years. X-ray film and visual analogue scale (VAS), American shoulder and elbow surgeon (ASES) score, Constant-Murley score, University of California, Los Angeles (UCLA) scoring system and simple shoulder test (SST) questionnaire were used to evaluate the patients' shoulder function recovery at final follow-up.
All the patients were followed up with an average time of 13 months. All fractures united within 8 weeks postoperatively. No infection, avascular necrosis or complications which concerning with hardware was found during follow-up. The average active forward flexion was 147.8 degrees , the average external rotation was 45.5 degrees and the average internal rotation was T10. The mean VAS score was 1.5. The mean ASES score, Constant-Murley score, UCLA score and SST score were 81.2, 85.4, 29.9 and 9.5 respectively. Eighteen patients were rated as "excellent" or "good", while 4 others were rated "poor". All patients were satisfied with their results.
With good indication control, meticulous intraoperative management and strict postoperative rehabilitation, close reduction and internal fixation with proximal humeral nail can be an effective method for the treatment of two-part surgical neck fracture.
探讨采用肱骨近端锁定髓内钉治疗肱骨近端二部分外科颈骨折的效果，并讨论其适应证、手术技术及有效性。
回顾性分析22例采用肱骨近端髓内钉固定的二部分外科颈骨折患者的资料。平均年龄57岁。采用X线片、视觉模拟评分法（VAS）、美国肩肘外科医师（ASES）评分、Constant-Murley评分、加州大学洛杉矶分校（UCLA）评分系统及简易肩关节测试（SST）问卷对患者末次随访时的肩关节功能恢复情况进行评估。
所有患者均获随访，平均随访时间13个月。所有骨折均在术后8周内愈合。随访期间未发现感染、缺血性坏死或与内固定相关的并发症。平均主动前屈147.8°，平均外旋45.5°，平均内旋至T10水平。VAS评分平均为1.5分。ASES评分、Constant-Murley评分、UCLA评分及SST评分的均值分别为81.2、85.4、29.9及9.5分。18例患者评定为“优”或“良”，4例评定为“差”。所有患者对治疗结果均满意。
严格掌握适应证，术中精细操作，术后严格康复训练，肱骨近端髓内钉闭合复位内固定可作为治疗二部分外科颈骨折的有效方法。
