Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA,
Curr Rev Musculoskelet Med. 2013 Mar;6(1):57-62. doi: 10.1007/s12178-012-9152-9.
Proximal humerus fractures are common injuries that are increasing in incidence with the aging of the population. While nonoperative treatment of some fracture patterns results in clinical success, other, more displaced and comminuted fractures may require surgery to ensure a successful outcome. It is important to evaluate both patient and fracture characteristics in deciding upon the appropriate type of treatment. Every effort should be made to perform a humeral sparing procedure in younger patients. In the elderly, especially with more complex four-part fractures and fracture dislocations, hemiarthroplasty and reverse total shoulder arthroplasty are indicated to decrease complication rates and improve functional outcomes. In hemiarthroplasties, it is critical to achieve proper implant height and positioning of the tuberosities. For those patients or fractures in which the tuberosities are unlikely to heal or cannot be adequately reconstructed, reverse total shoulder arthroplasty should be considered.
肱骨近端骨折是一种常见的损伤，随着人口老龄化，其发病率也在增加。虽然某些骨折类型的非手术治疗可以获得临床成功，但其他更移位和粉碎性骨折可能需要手术才能获得成功的结果。在决定适当的治疗类型时，评估患者和骨折的特征非常重要。应尽一切努力在年轻患者中进行保肱骨手术。对于老年人，尤其是更复杂的四部分骨折和骨折脱位，半肩关节置换术和反式全肩关节置换术是指征，以降低并发症发生率并改善功能结果。在半肩关节置换术中，关键是要获得适当的假体高度和结节的正确位置。对于那些结节不太可能愈合或不能充分重建的患者或骨折，应考虑进行反式全肩关节置换术。
