Rees J, Hicks J, Ribbans W
Department of Orthopaedics, Northampton General Hospital, England.
Clin Orthop Relat Res. 1998 Aug(353):18-29. doi: 10.1097/00003086-199808000-00004.
Three-and four-part comminuted fractures of the proximal humerus are difficult and technically demanding to treat. The various treatment methods reported in the literature are reviewed. It is recommended that three-part fractures be treated with open reduction and internal fixation. Four-part fractures in the younger, active patient also can be treated successfully with open reduction and internal fixation. However, in the elderly and in the patient with osteoporosis, a hemiarthroplasty is the treatment of choice. There is a need for universal agreement on a scoring system for measuring outcome in these fractures to allow a meaningful comparison between reported treatment methods.
肱骨近端的三部分和四部分粉碎性骨折治疗起来困难且技术要求高。本文回顾了文献中报道的各种治疗方法。建议对三部分骨折采用切开复位内固定术治疗。对于较年轻、活动量较大的患者，四部分骨折也可通过切开复位内固定术成功治疗。然而，对于老年患者和骨质疏松患者，半关节置换术是首选的治疗方法。有必要就这些骨折的疗效评估评分系统达成普遍共识，以便对所报道的治疗方法进行有意义的比较。
