Yu Zhe, Zheng Lianhe, Yan Xiaodong, Li Xiaoxiang, Zhao Jian, Ma Bao'an
Department of Orthopedic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
Adv Clin Exp Med. 2017 Mar-Apr;26(2):287-293. doi: 10.17219/acem/28898.
Displaced proximal humeral fractures remain a challenge to orthopedic surgeons.
The purpose of this study was to evaluate the functional and radiological outcomes of patients with comminuted proximal humeral fractures treated with closed reduction and percutaneous screw fixation (CRPF).
The authors retrospectively reviewed 38 cases of displaced proximal humeral fractures (2-, 3- or 4-part fractures according to the Neer classification) that were treated using the CRPF technique from May 2009 to April 2013. From this group 26 patients were followed up for a period ranging from 9 to 24 months (averaging 12.9 months) and evaluated for the functional and radiological outcomes by a series of standard questionnaires and measurements.
The fractures in all 26 patients were healed within an average time of 14.6 weeks (ranging from 11 to 27 weeks), and the mean interval between the operation and fully functional activity was 18.6 weeks (ranging from 15 to 32 weeks). At the final follow-up visit, no patient showed shoulder instability; the mean range of abduction motion was 146.5° (ranging from 72° to 180°). For all patients, no statistically significant difference in the functional outcomes was observed between their 6-month and final follow-up visits; or in the radiological findings between their immediate post-operative and final follow-up examinations.
The CRPF technique is a safe and effective therapeutic option for comminuted proximal humeral fractures. Good stability is obtained and aggressive impairment of the soft tissue and periosteum around the fracture is avoided, which allows for an early painless range of motion. The technique promotes bone healing, prevents ischemic osteonecrosis of the head of the humerus and leads to few complications.
肱骨近端移位骨折对骨科医生来说仍是一项挑战。
本研究旨在评估采用闭合复位经皮螺钉固定术（CRPF）治疗的肱骨近端粉碎性骨折患者的功能和影像学结果。
作者回顾性分析了2009年5月至2013年4月间采用CRPF技术治疗的38例肱骨近端移位骨折（根据Neer分类为二部分、三部分或四部分骨折）。该组中有26例患者接受了9至24个月（平均12.9个月）的随访，并通过一系列标准问卷和测量对其功能和影像学结果进行评估。
所有26例患者的骨折平均在14.6周（11至27周）内愈合，手术至完全恢复功能活动的平均间隔时间为18.6周（15至32周）。在最后一次随访时，没有患者出现肩关节不稳定；外展运动的平均范围为146.5°（72°至180°）。对于所有患者，在6个月和最后一次随访时的功能结果之间，或在术后即刻和最后一次随访检查的影像学结果之间，均未观察到统计学上的显著差异。
CRPF技术是治疗肱骨近端粉碎性骨折的一种安全有效的治疗选择。该技术可获得良好的稳定性，避免对骨折周围软组织和骨膜的过度损伤，从而实现早期无痛的活动范围。该技术促进骨折愈合，预防肱骨头缺血性坏死，且并发症较少。
