Khmelnitskaya Ekaterina, Lamont Lauren E, Taylor Samuel A, Lorich Dean G, Dines David M, Dines Joshua S
Sports Medicine and Shoulder Service, Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Adv Orthop. 2012;2012:861598. doi: 10.1155/2012/861598. Epub 2012 Dec 18.
Proximal humerus fractures are common injuries, especially among older osteoporotic women. Restoration of function requires a thorough understanding of the neurovascular, musculotendinous, and bony anatomy. This paper addresses the relevant anatomy and highlights various management options, including indication for arthroplasty. In the vast majority of cases, proximal humerus fractures may be treated nonoperatively. In the case of displaced fractures, when surgical intervention may be pursued, numerous constructs have been investigated. Of these, the proximal humerus locking plate is the most widely used. Arthroplasty is generally reserved for comminuted 4-part fractures, head-split fractures, or fractures with significant underlying arthritic changes. Reverse total shoulder arthroplasty is reserved for patients with a deficient rotator cuff, or highly comminuted tuberosities.
肱骨近端骨折是常见损伤，尤其在老年骨质疏松女性中更为多见。功能恢复需要全面了解神经血管、肌腱和骨骼解剖结构。本文阐述了相关解剖结构，并重点介绍了包括关节置换术适应证在内的各种治疗选择。在绝大多数情况下，肱骨近端骨折可采用非手术治疗。对于移位骨折，若考虑手术干预，已有多种内固定方式被研究。其中，肱骨近端锁定钢板应用最为广泛。关节置换术一般适用于粉碎性四部分骨折、头劈裂骨折或伴有明显潜在关节炎改变的骨折。反式全肩关节置换术适用于肩袖功能不全或大结节高度粉碎的患者。
