External Skeletal Fixation for Proximal Humeral Fracture Results

骨外固定器治療肱骨近端骨折

10.6200/TCMJ.2006.3.3.12

施世亮(Shih-Liang Shih)；楊瑞成(Richard Yang)；孫瑞昇(Jui-Sheng Sun)；施天岳(Tein-Yen Shih)；曾永輝(Yang-Hwei Tsuang)

上端肱骨骨折 ； 閉鎖式復位 ； 骨外固定器 ； close reduction ； external skeletal fixation ； proximal humeral fracture

北市醫學雜誌

3卷3期（2006 / 03 / 01）

300 - 309

英文

目的：以開放復位及內固定來治療肱骨近端的骨折是常用，但困難度也高的方法，特別是對於骨質較差及粉碎度較高的病人。多數接受這種手術的病人在術後即使接受長期的復健，或多或少還有功能上的喪失。此外，由於大範圍的肌肉剝離，也常造成日後肱骨頭部缺血性壞死。方法：我們以閉鎖性復位及骨外固定器治療十八位病患，其中八位的骨折程度屬於尼爾氏二部份骨折，十位屬於尼爾氏三部份骨折。病人於手術後三天內出院，每兩週於門診追蹤X光片及骨外固定器皮膚穿孔傷口。若無併發症出現，外固定器於六週後拔除。結果：除了一為患有腎衰竭並已接受長期洗腎治療的病患外，其他所有的病人骨折在平均八個月的追蹤都有良好的癒合。受傷側的肩關節功能恢復良好，手術時間短,且出血量少，僅有少數的副作用發生，沒有缺血性肱骨頭部壞死的病例。結論：以閉鎖式復位及骨外固定器固近端肱骨骨折的效果良好，尤其對於屬於麻醉高危險群的患者是值得嘗試的方法。

Background and Purpose: Open reduction and internal fixation for proximal humeral two-or three-part fractures is a technique-demanded procedure, especially in comminuted fractures. Most patients who had taken such procedures remained functional impaired after a long term of physical therapy. Besides, avascular necrosis would be a sequela if there was extensive soft tissue stripped from proximal humerus for anatomic reduction or for implant application. Methods: Eighteen patients with proximal humeral fracture receiving operative treatment by close reduction and external fixation were retrospectively evaluated. Eight of these patients were classified as two-part fracture, and ten of these patients were classified as three-part fracture, according to Neer's criteria. All patients were clinically examined and standard shoulder radiographs were obtained at the time of follow-up. Results: All but one fractures healed. Most patients showed good to excellent results. There is rare complication in this procedure. Conclusion: External fixation for proximal humeral two or three parts fracture could offer a reliable good outcome.