Lee C K, Hansen H R
J Trauma. 1981 Sep;21(9):788-91. doi: 10.1097/00005373-198109000-00006.
Nineteen patients with displaced four-part fracture or fracture-dislocation of the proximal humerus were retrospectively studied to investigate the incidence of avascular necrosis and its clinical importance. The average followup duration was 23.6 months. No incidence of avascular necrosis of the humeral head with subchondral collapse was found. Four patients were found to have coarse trabeculae suggesting a revascularized humeral head which probably had become necrotic after the trauma. The treatment of choice for displaced four-part fracture or fracture-dislocation of the proximal humeral is early adequate open reduction and internal fixation rather than primary prosthetic replacement. The authors believe that a majority of the humeral heads in this injury develop avascular necrosis, but most of the humeral heads are quickly revascularized with creeping substitution.
对19例肱骨近端移位四部分骨折或骨折脱位患者进行回顾性研究，以调查缺血性坏死的发生率及其临床意义。平均随访时间为23.6个月。未发现肱骨头缺血性坏死伴软骨下塌陷的情况。发现4例患者有粗大的骨小梁，提示肱骨头已重新血管化，可能在创伤后发生了坏死。对于肱骨近端移位四部分骨折或骨折脱位，首选的治疗方法是早期进行充分的切开复位内固定，而不是一期假体置换。作者认为，这种损伤中的大多数肱骨头会发生缺血性坏死，但大多数肱骨头会通过爬行替代迅速重新血管化。
