Gahr R H, Imhoff M, Sadr I, Tassler H
Unfallchirurgische Klinik, Städtischen Kliniken Dortmund.
Z Unfallchir Versicherungsmed. 1990;83(4):206-18.
From 1978 to 1989 178 patients were treated for humerus fractures of the surgical neck. An examination after an average of 9 months showed in 119 cases of dislocation of the humerus of less than one shaft width no significant differences between conservative and operative treatment. In case of major dislocation of more than one shaft width (n = 59) operative treatment resulted in significantly better functional results in all age groups. A wider indication for operation after 1986 lead to better results even in the elder patients. Younger patients profited by an operative treatment even in case of minor dislocation, especially as regards maximum mobility of the shoulder joint. In most cases percutaneous or open drill-wire osteosynthesis was preferred. It is concluded that in elder patients only humerus fractures of the surgical neck with major dislocations should be operated upon. With younger patients an indication for operative treatment can also be seen in cases with minor dislocation. Nevertheless, the fractures of the proximal humerus, even in case of an increased operative treatment, remain a field of conservative therapy.
1978年至1989年期间，178例患者接受了肱骨外科颈骨折治疗。平均9个月后的检查显示，在119例肱骨干移位小于一个骨干宽度的病例中，保守治疗和手术治疗之间无显著差异。在骨干移位超过一个骨干宽度的严重移位病例（n = 59）中，手术治疗在所有年龄组中均产生了明显更好的功能结果。1986年后更广泛的手术指征即使在老年患者中也带来了更好的结果。年轻患者即使在轻度移位的情况下接受手术治疗也有益处，尤其是在肩关节最大活动度方面。在大多数情况下，首选经皮或切开穿针钢丝内固定术。得出的结论是，老年患者仅应对伴有严重移位的肱骨外科颈骨折进行手术。对于年轻患者，轻度移位的病例也可考虑手术治疗指征。然而，即使手术治疗增加，肱骨近端骨折仍是保守治疗的领域。
