目的

回顾性分析经单一前方入路治疗肱骨近端骨折合并肱骨头后脱位的临床结果，总结手术治疗经验。

方法

对2013 年1 月至2023 年12 月期间应用单一前方入路切开复位内固定治疗的肱骨近端骨折合并肱骨头脱位的26 例（29 肩）患者进行回顾性分析。收集患者的性别、年龄、受伤原因、受伤类型、受伤至手术时间、手术出血量、骨折形态等信息，术后随访内容包括肩关节X 线片、美国加州大学肩关节功能评分（the university of California at Los Angeles shoulder rating scale，UCLA）、Constant 评分、视觉模拟评分（visual analogue scale，VAS）以及并发症发生情况等。

结果

23 例患者（26 肩）获得随访，随访时间平均（43.1±11.0）个月。26 肩的关节脱位及骨折均复位良好，无再脱位病例，所有骨折均获得临床愈合，骨折愈合时间平均（12.4±3.2）周。术后1 个月及末次随访的Constant 评分、UCLA 评分、VAS 评分以及肩关节前屈、外展、内旋范围均较术前明显改善。陈旧损伤组与新鲜损伤组比较，术后的前屈功能、外展功能较差，两组有统计学差异。不同性别、年龄以及骨折类型的术后评估结果没有统计学差异。发生肱骨头坏死2 例，无术后感染、内固定物失效以及医源性神经及血管损伤等并发症。

结论

经单一前方入路切开复位内固定治疗肱骨近端骨折合并肱骨头后脱位可以获得较好临床效果，陈旧性病例肩关节前屈及外展功能较新鲜病例差。避免漏诊，尽早进行手术。术中应充分显露病变部位，确保在直视下完成关节和骨折的复位固定，同时注意保护肱骨头的血运，以提高治疗效果。

Background

Proximal humerus fractures are common， accounting for about 4%of total fractures. However， proximal humerus fractures combined with humeral head dislocations are uncommon， especially those with posterior dislocations of the humeral head， accounting for about 0.9%of shoulder fractures and dislocations. The causes of dislocations after proximal humeral fractures mainly include fall injury， traffic injury， electric shock injury， etc. The surgical effect of proximal humeral fracture combined with the posterior dislocation of the humeral head is rarely reported in the literature， and the choice of surgical approach and surgical method is still controversial.

Objective

To retrospectively analyze the cases of proximal humeral fracture combined with the posterior dislocation of the humeral head treated through the single anterior approach， explore the clinical results， and summarize the surgical treatment experience.

Methods

A retrospective analysis was performed on 26 patients （29 shoulders）with proximal humeral fractures combined with the posterior dislocations of the humeral head treated by open reduction and internal fixation via the single anterior approach between January 2013 and December 2023. Information such as gender， age， cause of injury， type of injury， time from injury to operation， amount of operative blood loss， fracture morphology， and other information were collected. Postoperative followups included shoulder joint X-ray film， shoulder joint function UCLA score， Constant score， pain VAS score，and incidence of complications.

Results

Twenty-three patients （26 shoulders） were followed up for an average of 43.1±11.0 （11-72） months. Twenty-six shoulder fractures and dislocations were all well reduced，and no further dislocation was reported. All fractures were clinically healed with a mean healing time of 12.4±3.2 （8-16） weeks. The Constant score， UCLA score， VAS score， and ranges of shoulder flexion，abduction， and rotation were significantly improved in the 1st month after surgery and the last followup. Compared with the fresh injury group， the ranges of flexion and abduction in the aged damage were worse after the operation， and there were statistical differences between the two groups. There was no significant difference in postoperative evaluation results of sex， age， and fracture types. There were 2 cases of humeral head necrosis， and no complications such as postoperative infection， failure of internal fixation， and iatrogenic nerve or vascular injury.

Conclusion

Open reduction and internal fixation through the single anterior approach can achieve better clinical results in treating proximal humeral fracture combined with the posterior dislocation of the humeral head. The aged-damage cases have worse shoulder flexion and abduction function than the fresh cases. Surgery should be performed as soon as possible to avoid the missed diagnosis. During the operation， the diseased part should be fully exposed to ensure the reduction and fixation of the joint and fracture under direct vision， and the blood flow of the humeral head should be protected to improve the therapeutic effect.