Gerber C
Universitätsklinik für Orthopädische Chirurgie, Inselspital, Bern.
Orthopade. 1990 Nov;19(6):316-23.
Malunion, avascular necrosis of the head segment and nonunion of the neck are the most frequent complications of displaced fractures of the proximal humerus. Malunion of the tuberosities may be well tolerated or it can require surgical treatment. Cranial displacement of the greater tuberosity appears to be much better tolerated than dorsal displacement. If power and active mobility are maintained but pain persists, the malunion may have led to impingement, which can be relieved by coraco-acromioplasty. If active mobility is reduced, tubercular osteotomy and relocation using tension band wiring techniques may be warranted. Malunion at the neck level may be treated with subcapital, usually flexion-abduction, osteotomies and yield excellent results. A collapsed head segment after avascular necrosis of the head requires either hemiarthroplasty or total joint replacement. As the nonunions are usually fairly distal and almost always extra-articular, they are treated with open reduction and internal fixation using tension band-wiring techniques and autogenous bone grafting. Arthrodesis has essentially lost its role in reconstructive surgery after fracture complications and is only used if severe additional problems are present such as infection, neurological problems, or severe soft tissue defects.
畸形愈合、肱骨头缺血性坏死以及肱骨干骺端不愈合是肱骨近端移位骨折最常见的并发症。结节的畸形愈合可能耐受性良好，也可能需要手术治疗。大结节的颅侧移位似乎比背侧移位的耐受性好得多。如果力量和主动活动度得以维持但仍有疼痛，畸形愈合可能导致撞击，可通过喙肩峰成形术缓解。如果主动活动度降低，可能需要采用张力带钢丝技术进行结节截骨和复位。颈部水平的畸形愈合可采用通常为屈曲外展的头下截骨术治疗，效果良好。肱骨头缺血性坏死后出现的塌陷肱骨头需要进行半关节成形术或全关节置换。由于不愈合通常相当靠近远端且几乎总是关节外的，因此采用张力带钢丝技术切开复位内固定和自体骨移植进行治疗。关节融合术在骨折并发症后的重建手术中基本上已不再使用，仅在存在严重附加问题（如感染、神经问题或严重软组织缺损）时才使用。
