Ballmer F T, Hertel R
Universitätsklinik für Orthopädische Chirurgie, Inselspital, Bern.
Ther Umsch. 1998 Mar;55(3):197-202.
Complex fractures of the proximal humerus are uncommon injuries and a therapeutic challenge to the orthopaedic surgeon. Successful treatment requires proper evaluation of the patient and analysis of standardized high-quality radiographs. The trauma series of radiographs (including true anteroposterior and lateral views in the scapular plane, and axillary view) is essential for accurate fracture assessment. Generally, joint-preserving reconstructive techniques are emphasized, aiming at restoration of the anatomy of the proximal humerus. In young individuals with excellent quality of the bone fragments, careful techniques of reduction and fixation, avoiding additional surgical devascularization, should be performed, even in case of possible impairment of the vascular supply to the humeral head. In elderly individuals with osteoporotic bone and limited compliance throughout aftercare, humeral head replacement may be indicated less restrictively. In the latter group hemiarthoplasty generally can be expected to result in painfree shoulders. However, recovery of function and range of motion are much less predictable.
肱骨近端复杂骨折是一种少见的损伤，对骨科医生来说是一项治疗挑战。成功的治疗需要对患者进行恰当评估并分析标准化的高质量X线片。创伤系列X线片（包括肩胛平面真正的前后位和侧位片以及腋位片）对于准确的骨折评估至关重要。一般来说，强调保留关节的重建技术，目标是恢复肱骨近端的解剖结构。对于骨碎片质量良好的年轻患者，应实施仔细的复位和固定技术，避免额外的手术性血运破坏，即使肱骨头血供可能受损。对于骨质疏松且术后护理依从性有限的老年患者，可放宽肱骨头置换的指征。在后一组患者中，半关节成形术一般可望使肩部无痛。然而，功能和活动范围的恢复则更难预测。
