Zuckerman J D, Flugstad D L, Teitz C C, King H A
Clin Orthop Relat Res. 1984 Oct(189):234-7.
Proximal humeral fractures are commonly seen in orthopedic practice. The vast majority of these fractures are nondisplaced. Infrequently, displaced proximal humeral fractures have associated neurovascular injuries. Injury to the brachial plexus is uncommon; axillary artery injury is rare. This is a report of two displaced proximal humeral fractures in elderly, intoxicated patients following low-energy trauma. Both fractures resulted in axillary artery injury requiring vascular reconstruction. Only nine similar cases were found in a review of the literature. Displaced proximal humeral fractures should be carefully evaluated for vascular injury, and arteriography should be used when necessary. If vascular reconstruction is indicated, the fracture must be internally fixed to prevent redisplacement and potential compromise of the vascular repair. Serial postoperative Doppler examinations are necessary to detect thrombus formation. With prompt diagnosis and treatment, prolonged limb ischemia and its sequelae can be prevented.
肱骨近端骨折在骨科临床中较为常见。这些骨折绝大多数无移位。偶尔，移位的肱骨近端骨折会伴有神经血管损伤。臂丛神经损伤并不常见；腋动脉损伤则很罕见。本文报告了两例老年醉酒患者在低能量创伤后发生的移位肱骨近端骨折。两例骨折均导致腋动脉损伤，需要进行血管重建。在文献回顾中仅发现9例类似病例。对于移位的肱骨近端骨折，应仔细评估是否存在血管损伤，必要时应进行动脉造影。如果需要进行血管重建，必须对骨折进行内固定，以防止再次移位以及可能影响血管修复。术后需进行系列多普勒检查以检测血栓形成。通过及时的诊断和治疗，可预防肢体长期缺血及其后遗症。
