Laux Christoph J, Grubhofer Florian, Werner Clément M L, Simmen Hans-Peter, Osterhoff Georg
Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
J Orthop Surg Res. 2017 Sep 25;12(1):137. doi: 10.1186/s13018-017-0639-3.
Despite numerous available treatment strategies, the management of complex proximal humeral fractures remains demanding. Impaired bone quality and considerable comorbidities pose special challenges in the growing aging population. Complications after operative treatment are frequent, in particular loss of reduction with varus malalignment and subsequent screw cutout. Locking plate fixation has become a standard in stabilizing these fractures, but surgical revision rates of up to 25% stagnate at high levels. Therefore, it seems of utmost importance to select the right treatment for the right patient. This article provides an overview of available classification systems, indications for operative treatment, important pathoanatomic principles, and latest surgical strategies in locking plate fixation. The importance of correct reduction of the medial cortices, the use of calcar screws, augmentation with bone cement, double-plate fixation, and auxiliary intramedullary bone graft stabilization are discussed in detail.
尽管有众多可用的治疗策略，但复杂的肱骨近端骨折的治疗仍然具有挑战性。在不断老龄化的人群中，骨质受损和相当多的合并症带来了特殊的挑战。手术治疗后的并发症很常见，尤其是复位丢失伴内翻畸形以及随后的螺钉穿出。锁定钢板固定已成为稳定这些骨折的标准方法，但高达25%的手术翻修率一直居高不下。因此，为合适的患者选择正确的治疗方法似乎至关重要。本文概述了可用的分类系统、手术治疗的适应症、重要的病理解剖学原则以及锁定钢板固定的最新手术策略。详细讨论了正确复位内侧皮质、使用距骨螺钉、骨水泥增强、双钢板固定以及辅助髓内骨移植稳定的重要性。
