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中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (03) : 284 -287. doi: 10.3877/cma.j.issn.2095-5790.2023.03.014

综述

肱骨近端骨折术后功能康复策略现状及新理念下的研究进展
李立, 王红莉, 常红, 张艳()   
  1. 100044 北京大学人民医院创伤骨科 国家创伤医学中心 创伤救治与神经再生教育部重点实验室
  • 收稿日期:2023-04-20 出版日期:2023-08-05
  • 通信作者: 张艳
  • 基金资助:
    教育部创新团队项目(IRT_16R01); 北京大学医学部学院建设项目(2020)-国家创伤医学中心(BMU2020XY005-01); 北京大学医学部学院建设项目(2020)-创伤救治与神经再生教育部重点实验室(BMU2020XY005-03); 北京大学人民医院建设项目(2021)-国家创伤医学中心(BMU2021XY008-01); 北京大学人民医院建设项目(2021)-创伤救治与神经再生教育部重点实验室(BMU2021XY008-03); 创伤救治与神经再生教育部重点实验室学科建设(BMU2022JDJS008)

Current status of postoperative functional rehabilitation strategies for proximal humeral fractures and research progress under new concept

Li Li, Hongli Wang, Hong Chang   

  • Received:2023-04-20 Published:2023-08-05
引用本文:

李立, 王红莉, 常红, 张艳. 肱骨近端骨折术后功能康复策略现状及新理念下的研究进展[J]. 中华肩肘外科电子杂志, 2023, 11(03): 284-287.

Li Li, Hongli Wang, Hong Chang. Current status of postoperative functional rehabilitation strategies for proximal humeral fractures and research progress under new concept[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(03): 284-287.

肱骨近端骨折是常见的老年骨质疏松性骨折,接骨板或髓内钉内固定治疗是目前的主流治疗方案,通过多角度螺钉的置入以增加对肱骨近端骨质的把持力。有效的功能康复锻炼可以改善肱骨近端骨折内固定术后的肩关节活动度,提高生活质量,但不恰当的功能康复时机可能是导致骨折术后骨不连、肱骨头坏死以及内植物失效的原因。本文从肱骨近端骨折术后的早期康复锻炼入手,结合"悬臂-杠杆重建-不稳定"理论,进一步分析了肱骨近端固定后的"悬臂杠杆结构",并指出肱骨近端骨折内固定后形成绝对省力的杠杆结构,早期各向活动导致肱骨头内螺钉受力发生交替性改变,进而挤压破坏肱骨近端骨质,引发肱骨近端内固定相关并发症。该理论揭示了目前肱骨近端骨折术后内固定失效的本质是不合理的康复锻炼对骨和内植物产生的"支撑-牵张"效应。以该理论为基础,本文作者提出了肱骨近端内固定后新的康复策略和理念,将为不同肩部病损的康复带来新的思路和方法。

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