切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2026, Vol. 14 ›› Issue (02) : 65 -70. doi: 10.3877/cma.j.issn.2095-5790.2026.02.001

述评

肱骨头及内外前侧结构在肱骨近端骨折手术治疗中的临床意义
吴剑宏, 毕春, 黄寅骏, 王琦, 吴晓明()   
  1. 201620 上海市第一人民医院创伤中心骨科
  • 收稿日期:2026-04-09 出版日期:2026-05-05
  • 通信作者: 吴晓明
  • 基金资助:
    上海市松江区科技攻关(2024SJKJGG056)

Clinical significance of humeral head and its medial, lateral and anterior structures in surgical treatment of proximal humeral fractures

Jianhong Wu, Chun Bi, Yinjun Huang   

  • Received:2026-04-09 Published:2026-05-05
引用本文:

吴剑宏, 毕春, 黄寅骏, 王琦, 吴晓明. 肱骨头及内外前侧结构在肱骨近端骨折手术治疗中的临床意义[J/OL]. 中华肩肘外科电子杂志, 2026, 14(02): 65-70.

Jianhong Wu, Chun Bi, Yinjun Huang. Clinical significance of humeral head and its medial, lateral and anterior structures in surgical treatment of proximal humeral fractures[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2026, 14(02): 65-70.

肱骨近端骨折是肩部常见创伤之一,其手术治疗效果与肱骨近端各解剖结构的损伤程度、术中复位及重建质量密切相关。本文通过回顾相关文献,系统阐述肱骨头、内侧、外侧及前侧结构的解剖与功能特点,探讨各解剖结构对手术治疗及预后的临床价值:(1)肱骨头:恢复颈干角及后倾角是评估肱骨近端骨折稳定性、复位质量及预后的重要指标;(2)内侧力学侧:内侧距是维持术后力学稳定、促进骨折愈合的关键结构;(3)外侧功能侧:肱骨大结节作为肩袖重要附着点,是术后肩关节外展、外旋功能恢复的关键;(4)前侧症状侧:结节间沟复合体内肱二头肌长头腱损伤是术后肩关节疼痛症状的重要诱因。手术治疗需强调:(1)恢复肱骨头角度;(2)提供内侧力学侧的稳定支撑;(3)精准修复外侧功能侧及前侧症状侧,实施以解剖为基础的个体化治疗策略,为提升肱骨近端骨折手术治疗效果、改善患者肩关节功能预后提供参考依据。

图1 肱骨近端主要骨性结构
图2 颈干角与后倾角测量示意图 图A:颈干角;图B:后倾角
表1 大结节骨折不同固定方式适应证、优缺点及证据等级
表2 AVN高危因素及防护策略
图3 临床决策流程图注:AVN为缺血性坏死;ORIF为切开复位内固定
[1]
Chakravarty K, Webley M. Shoulder joint movement and its relationship to disability in the elderly[J]. J Rheumatol, 1993,20(8):1359-1361.
Connors G, Rasmussen S, Mahmoud Y, et al. Changing demographic and treatment trends of proximal humerus fractures: a TriNetX analysis of 74,781 patients[J]. J Am Acad Orthop Surg Glob Res Rev, 2025,9(8):e24.00356.
[2]
Kalacun D, Komadina R, Brilej D. Proximal humerus fractures in the elderly: work up, classifications and fracture biomechanics[J]. Eur J Trauma Emerg Surg, 2025,51(1):300.
[3]
Kale S, Patil S, Desai A, et al. Proximal humeral internal locking system plating in proximal humeral fractures - avoiding failure - narrative review[J]. J Clin Orthop, 2026,10(2):56-60.
[4]
Cancio-Bello AM, Barlow JD. Avascular Necrosis and Posttraumatic Arthritis After Proximal Humerus Fracture Internal Fixation: Evaluation and Management[J]. Curr Rev Musculoskelet Med2023,16(2):66-74.
[5]
De Joseph J, Gandhi PA, Padhi BK. PHILOS (Proximal Humerus Internal Locking System) Plating vs MultiLoc Nailing in Proximal Humerus Fracture: Systematic Review and Meta-Analysis of Radiological and Functional Outcomes[J]. Cureus, 2024,16(10):e72251.
[6]
Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures[J]. J Bone Joint Surg Am2004,86(Pt 2):143-155.
[7]
Wang Q, Sheng N, Rui B,et al. The neck-shaft angle is the key factor for the positioning of calcar screw when treating proximal humeral fractures with a locking plate[J]. Bone Joint J, 2020,102-B(12):1629-1635.
[8]
Testa EJ, Kutschke MJ, He E, et al. Biomechanics and Pathoanatomy of Posterior Shoulder Instability[J]. Clin Sports Med, 2024,43(4):723-735.
[9]
Hoffmeister T, Cass Z, Levy JC, et al. The role of glenoid version in arthroplasty[J]. JSES Rev Rep Tech, 2026,6(2):100682.
[10]
Imhoff FB, Camenzind RS, Obopilwe E,et al. Glenoid retroversion is an important factor for humeral head centration and the biomechanics of posterior shoulder stability[J]. Knee Surg Sports Traumatol Arthrosc, 2019,27(12):3952-3961.
[11]
Ranieri R, Anzillotti G, Rose GD, et al. Anatomical total shoulder arthroplasty revision to reverse shoulder arthroplasty using convertible glenoid: a systematic review of clinical and radiological outcomes[J]. Int Orthop, 2024,48(9):2411-2419.
[12]
Ren H, Wu LH, Zhang X,et al. The effect of integrity of lesser tuberosity-medial calcar on postoperative outcome in the proximal humeral fracture[J]. J Orthop Surg Res, 2023,18(1):363.
[13]
Hung CY, Yeh CY, Wen PC, et al. The effect of medial calcar support on proximal humeral fractures treated with locking plates[J]. J Orthop Surg Res, 2022,17(1):467.
[14]
Akhtar A, Richards J, Monga P. The biomechanics of the rotator cuff in health and disease - A narrative review[J]. J Clin Orthop Trauma, 2021,18:150-156.
[15]
Kumar S, Mishra A, Singh H,et al. Surgical fixation of isolated greater tuberosity fractures of the humerus- systematic review and meta-analysis[J]. J Clin Orthop Trauma, 2021,27:101670.
[16]
Bono CM, Renard R, Levine RG, et al. Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder[J]. J Bone Joint Surg Br, 2001,83(7):1056-1062.
[17]
Nóbrega Catelas D, Correia L, Adan E Silva F, et al. Greater tuberosity fractures of the humerus: complications and long-term outcomes after surgical treatment[J]. Eur J Orthop Surg Traumatol, 2024,34(5):2541-2547.
[18]
Levy DM, Erickson BJ, Harris JD, et al. Management of Isolated Greater Tuberosity Fractures: A Systematic Review[J]. Am J Orthop (Belle Mead NJ), 2017,46(6):E445-E453.
[19]
Koukos C, Giotis D, Troullinakis M,et al. Evaluation of a Novel Suture-Button Technique for Open Reduction and Internal Fixation in Isolated Fractures of the Greater Tuberosity of the Humerus: A Retrospective Study[J]. Cureus, 2025,17(3):e81514.
[20]
Molokwu B, Xu J, Myerson CL, et al. Outcomes of Displaced Greater Tuberosity Fractures Treated with Screw Fixation and Double Row Suture Bridge Technique[J].Arch Orthop Trauma Surg, 2025,145(1):461.
[21]
Ozturk B, Afacan MY, Hajizadeh M,et al. An Isolated Greater Tuberosity Fracture With Posterior-Superior Displacement in an Elderly Patient: Successful Fixation Using Cannulated Screws With Washers Without Rotator Cuff Repair[J]. Cureus, 2025,17(8):e91273.
[22]
Lee WY, Shin HD, Kim KC,et al. Open Reduction and Stable Internal Fixation Using a 3.5-mm Locking Hook Plate for Isolated Fractures of the Greater Tuberosity of the Humerus: A 2-Year Follow-up Study Using an Innovative Fixation Method[J]. Clin Orthop Surg, 2021,13(3):293-300.
[23]
Lee HJ, Joung S, Kholinne E,et al. The use of the bicipital groove as an intraoperative landmark for proximal humeral rotation during fracture fixation[J]. Ewha Med J, 2024,47(2):e25.
[24]
Kerschbaum M, Werth M, Gerhardt C,et al. Simultaneous surgical treatment of the long head of the biceps tendon during operative treatment of proximal humeral fractures[J]. Unfallchirurg, 2017,120(10):865-872.
[25]
Van Deurzen DFP, Garssen FL, Kerkhoffs GMMJ, et al. Clinical relevance of the anatomy of the long head bicipital groove, an evidence-based review[J]. Clin Anat, 2021,34(2):199-208.
[26]
Baumann AN, Talaski GM, Fiorentino A,et al. Examining the Dimensions of the Bicipital Groove: A Human Cadaveric Study[J]. Cureus, 2023,15(12):e50895.
[27]
Younis Z, Hamid MA, Amin J, et al. Proximal Humerus Fractures: A Review of Anatomy, Classification, Management Strategies, and Complications[J]. Cureus, 2024,16(11):e73075.
[28]
Marco SV, Marco S, Alberto G,et al. Can Hertel Criteria Reliably Predict Avascular Necrosis After Intracapsular Proximal Humerus Fractures in the Elderly? A Retrospective Analysis[J]. J Pers Med,2026,16(1):34.
[29]
Da Silva T, Ehrhard DB, Chuchuy TM, et al. Protective and Risk Factors for Humerus Head Necrosis After Proximal Humerus Fracture Treated with Internal Locking Plate[J]. Indian J Orthop, 2021,56(3):429-436.
[30]
付慧娟,熊晨,张晓萌,等.肱骨近端骨折后肱骨头坏死的研究进展[J/OL].中华肩肘外科电子杂志, 2025,13(4): 250-253.
[31]
Ou ZX, Feng QY, Peng LQ, et al. Risk factors for osteonecrosis of the humeral head after internal fixation of proximal humeral fractures: a systematic review and meta-analysis[J]. Arch Orthop Trauma Surg, 2024,144(1):31-40.
[32]
Hertel R, Hempfing A, Stiehler M,et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus[J]. J Shoulder Elbow Surg, 2004,13(4):427-433.
[33]
Fazzari F, Canton G, Giraldi G,et al. Avascular necrosis of humeral head after proximal humerus fracture: Comparison between classification systems in predicting necrosis risk[J]. Acta Biomed, 2023,94(S2):e2023089.
[34]
de Giovanni R, Coppola M, Rossi V,et al. A Comprehensive Review of 3D Imaging and Printing in Proximal Humerus Fractures and Sequelae[J]. J Clin Med, 2025,14(21):7711.
[1] 杨邱亚, 罗渝昆, 王月香. 超声引导肩关节腔内药物注射治疗肩袖修复术后肩痛的临床研究[J/OL]. 中华医学超声杂志(电子版), 2026, 23(01): 60-66.
[2] 冯学乾, 王千丹, 张旭. 乳腺叶状肿瘤的诊疗进展与全程管理策略[J/OL]. 中华乳腺病杂志(电子版), 2026, 20(02): 115-119.
[3] 章建雄, 吴正豪, 乐佳迪, 陈龙. 股骨远端骨折-脱位新分类系统的提出以及临床建议[J/OL]. 中华关节外科杂志(电子版), 2026, 20(01): 116-121.
[4] 王晶, 李楷凡, 何秀明, 陈亚影, 郑晓宇, 王业杨. 关节镜下微骨折联合富血小板血浆治疗膝骨关节炎[J/OL]. 中华关节外科杂志(电子版), 2026, 20(01): 122-126.
[5] 焦瑞, 徐刚, 练慧斌, 殷志敏, 韩辉, 周杰. 骨盆骨折大出血患者动脉栓塞术后臀肌及皮肤坏死治疗方法的探讨[J/OL]. 中华损伤与修复杂志(电子版), 2026, 21(01): 7-11.
[6] 王宏, 董国强, 张兴洲, 刘韦鋆, 张楠. 机器人辅助对比腹腔镜下复杂腹壁疝手术短期疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(01): 68-73.
[7] 尤薇, 李青青, 金华, 王平, 周美玲, 陈樽, 黄永刚. 腹直肌分离补片修补手术对腹壁核心健康的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(01): 101-107.
[8] 王贇琛, 马孝忠, 蒋文明, 朱衡, 束昊. 关节镜下肱二头肌长头腱转位加强术联合肩袖部分修补术治疗巨大不可修复肩袖撕裂的临床疗效观察[J/OL]. 中华肩肘外科电子杂志, 2026, 14(01): 12-20.
[9] 孙懿贤, 朱金雨, 刘一超, 孙鲁宁. 反向全肩关节置换术治疗肱骨近端骨折内固定失败的疗效分析[J/OL]. 中华肩肘外科电子杂志, 2026, 14(01): 29-37.
[10] 陈赛文, 吴青杰, 林昱东, 张思成. 超声引导下闭合复位克氏针固定与切开复位克氏针固定治疗儿童肱骨内上髁骨折的疗效比较[J/OL]. 中华肩肘外科电子杂志, 2026, 14(01): 38-44.
[11] 帖小佳, 王莲朋, 蒋凌霄, 韩亚军. 肱骨近端骨折合并肩袖撕裂发生率的Meta分析[J/OL]. 中华肩肘外科电子杂志, 2026, 14(01): 45-52.
[12] 汪嘉曦, 叶曾盼盼, 冉茂兵, 刘文科. 儿童颅内巨大脑膜瘤一例报道[J/OL]. 中华神经创伤外科电子杂志, 2026, 12(01): 57-59.
[13] 杨延江, 程晓东, 王忠正, 李泳龙, 丁凯, 崔蕴威. 仿生空心螺钉与传统空心螺钉固定股骨颈骨折的生物力学对比研究[J/OL]. 中华老年骨科与康复电子杂志, 2026, 12(02): 99-105.
[14] 王晓伟, 杨红梅, 孙天胜, 刘智, 刘川, 高杰. 髓内钉治疗老年股骨转子间骨折术后内固定相关并发症预测模型建立与验证[J/OL]. 中华老年骨科与康复电子杂志, 2026, 12(01): 38-46.
[15] 李志军, 郭光鑫, 李艳辉, 石冬, 程月飞. 颅骨海绵状血管瘤一例报道并文献复习[J/OL]. 中华脑科疾病与康复杂志(电子版), 2026, 16(02): 122-124.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?