Zyto K, Kronberg M, Broström L A
Department of Orthopaedics, Södersjukhuset, Stockholm, Sweden.
J Shoulder Elbow Surg. 1995 Sep-Oct;4(5):331-6. doi: 10.1016/s1058-2746(95)80016-6.
It is difficult to predict the outcome of comminuted fractures of the proximal humerus and give guidelines for optimal treatment. Different treatment modalities are available, and there are various scoring systems for postoperative evaluation. The aim of this study was to assess the functional outcome after three- and four-part fractures of the humeral head in 38 patients, with a 3-year follow-up. Twenty-eight patients were treated conservatively, seven were operated on with open reduction and internal fixation, and three received a hemiarthroplasty. All patients were examined clinically and radiographically. Neer and Constant scoring systems were used. The functional outcome after three-part fractures was generally good. Twenty-five of 26 patients with a three-part fracture could accept their shoulder situation. Range of motion was significantly lower in the four-part fracture group. Mean flexion was 89 degrees compared with 120 degrees in the three-part fracture group. Necrosis of the humeral head was found in 2 cases, both four-part fractures. Osteoarthrosis developed in 13 cases (6 with a three-part fracture, 7 with a four-part fracture). No disability was found in 16 of 24 patients with three-part fractures, and in 4 of 11 patients with four-part fractures. There was strong agreement between the Constant score and the patients' opinions.
肱骨近端粉碎性骨折的预后难以预测，也难以给出最佳治疗指南。目前有不同的治疗方式，术后评估也有多种评分系统。本研究旨在对38例患者的肱骨头三部分和四部分骨折进行3年随访，评估其功能预后。28例患者接受保守治疗，7例行切开复位内固定手术，3例行半关节置换术。所有患者均进行了临床和影像学检查。采用Neer和Constant评分系统。三部分骨折后的功能预后总体良好。26例三部分骨折患者中有25例能够接受其肩部状况。四部分骨折组的活动范围明显较低。四部分骨折组的平均屈曲度为89度，而三部分骨折组为120度。2例出现肱骨头坏死，均为四部分骨折。13例发生骨关节炎（三部分骨折6例，四部分骨折7例）。24例三部分骨折患者中有16例、11例四部分骨折患者中有4例未出现残疾。Constant评分与患者意见之间存在高度一致性。
