【摘要】 目的　评价严重粉碎性肱骨近端骨折不同内固定技术的疗效 ,并证实钢板固定在其中的地位。方法　对 2 9例肱骨近端严重粉碎性骨折分别采用钢板及克氏针螺钉固定 ,并采用Neer分型及评分系统评价手术疗效。结果　三部分骨折小于 5 0岁年龄组中 ,钢板固定 5例 ,其中 2例优 ,2例良 ;而克氏针螺钉固定 4例 ,仅有 1例为良。三部分骨折大于 5 0岁年龄组中 ,两者相似。四部分骨折二种方法的优良率均较低。结论　三部分骨折 ,小于 5 0岁 ,骨质较好者 ,根据术者的经验可选用钢板固定 ;四部分骨折两种方法的疗效均较差 ,可以选择肱骨头置换更多还原

【Abstract】 Objective To evaluate different internal fixation techniques (plate fixation,screws or Kirschner wire) in comminuted and displaced fractures of the proximal humerus to verify if the plate fixation is still an adequate therapy in the treatment of displaced proximal humeral fractures.Methods We reviewed twenty nine patients who had been diagnosed as having comminuted and displaced proximal humeral fractures and had been operated on from February 1996 to June.2001 in our hospital.The mean follow up time was 2 8 years (9～73 months).Their age ranged from 17 to 71 years (average,39 5 years);19 patients were male and 10 female.Thirteen fractures were fixed with plates,and delto pectoral approach was adopted,16 fractures with c and plaster.Neer fracture classification system and rating system were used.Results Of three part fractures,and the age was lower than 50 years,excellent was 2 cases and good was 2 cases with plate fixation of 5 cases.merely 1 case was good with screw or Kirschner wire of 4 cases.In four part fractures,the rates of satisfaction with two methods are both low.Conclusion Based on our results and the reviewed literature we can confirm advantages of plate fixation techniques in the treatment of 3-part fractures.especially in the patient whose age is lower than 50 years and bone quality is good.In four part fractures,the results of the two methods are both poor.Humeral head replacement may be executed.更多还原