中国修复重建外科杂志

中国修复重建外科杂志

肱骨近端脱套样骨折治疗体会

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目的 总结一种新的肱骨近端骨折类型—肱骨近端脱套样骨折,并探讨其受伤机制、分型标准及治疗方法。 方法 回顾分析 2009 年 9 月—2016 年 9 月收治的 23 例肱骨近端脱套样骨折患者临床资料。男 14 例,女 9 例;年龄 21~66 岁,平均 39.7 岁。致伤原因:扭伤 2 例,高处跌落伤 8 例,交通事故伤 13 例。受伤至手术时间 3~116 d,平均 17.1 d。肱骨头后脱位 2 例、前脱位 3 例,其他部位骨折 3 例,臂丛损伤 2 例;均伴肩袖不同程度挫伤。根据自定骨折分型标准:内旋型 6 例,外旋型 14 例,外展型 3 例。23 例均行切开复位内固定术。 结果 23 例患者均获随访,随访时间 9~24 个月,平均 17 个月。切口均Ⅰ期愈合。X 线片复查示骨折均愈合,愈合时间 3~5 个月,平均 3.6 个月。术后 6 个月采用 Neer 标准进行肩关节功能评定:优 16 例、良 5 例、可 1 例、差 1 例,优良率 84.6%。术后 1 例发生肩袖再次撕裂,行二次手术修补。 结论 肱骨近端脱套样骨折可能为肩关节受到暴力后极度内旋、外旋和外展所致,经复位内固定治疗可获得确切疗效。治疗时注意除骨折复位固定外,肩袖修复及功能重建也是治疗成功的关键。

Objective To summarize a new type of proximal humerus fracture—proximal humerus degloving fracture, and discuss its injury mechanism, classification criteria, and treatment methods. Methods The clinical data of 23 patients with proximal humerus degloving fracture between September 2009 and September 2016 were retrospectively analyzed. There were 14 males and 9 females, with an average age of 39.7 years (range, 21-66 years). The causes of injury was sprain in 2 cases, falling from height in 8 cases, and traffic accident in 13 cases. The time from injury to operation was 3-116 days (mean, 17.1 days). There were 2 cases of posterior dislocation of humeral head, 3 cases of anterior dislocation of humeral head, 3 cases of other fracture, and 2 cases of brachial plexus injury. All patients had varying degrees of rotator cuff injury. According to the self-determined fracture classification criteria, there were 6 cases of internal rotation type, 14 cases of external rotation type, and 3 cases of abduction type. All patients underwent open reduction and internal fixation. Results All patients were followed up 9-24 months (mean, 17 months). All incisions healed by the first intention. X-ray films showed that all fractures healed at 3-5 months after operation (mean, 3.6 months). According to the Neer’s shoulder functional evaluation criteria at 6 months, the shoulder function was rated as excellent in 16 cases, good in 5 cases, fair in 1 case, and poor in 1 case, and the excellent and good rate was 84.6%. The rotator cuff tear recurred in 1 case and was repaired again. Conclusion The injury mechanism of proximal humerus degloving fracture may be the extreme internal rotation, extreme external rotation, or extreme abduction. Reduction and internal fixation is an effective treatment. The focus of the treatment is not only the fixation of the fracture, but also the repair and reconstruction of the rotator cuff.

关键词: 肱骨近端脱套样骨折; 骨折分型; 内固定

Key words: Proximal humerus degloving fracture; fracture classification; internal fixation

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