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中华肩肘外科电子杂志 ›› 2026, Vol. 14 ›› Issue (03) : 185 -190. doi: 10.3877/cma.j.issn.2095-5790.2026.03.009

综述

肱骨近端骨折内固定术后并发症:力学失稳与血供损伤机制
施崡, 张一翀(), 张殿英()   
  1. 100044 北京大学人民医院创伤骨科
  • 收稿日期:2026-04-30 出版日期:2026-08-05
  • 通信作者: 张一翀, 张殿英
  • 基金资助:
    国家重点研发计划(2023YFC2509900、2023YFC2509902); 北京大学临床科学家培养计划项目(BMU2026PYJH037)

Postoperative complications after internal fixation of proximal humeral fractures: mechanical instability and blood supply injury mechanisms

Han Shi, Yichong Zhang(), Dianying Zhang()   

  • Received:2026-04-30 Published:2026-08-05
  • Corresponding author: Yichong Zhang, Dianying Zhang
引用本文:

施崡, 张一翀, 张殿英. 肱骨近端骨折内固定术后并发症:力学失稳与血供损伤机制[J/OL]. 中华肩肘外科电子杂志, 2026, 14(03): 185-190.

Han Shi, Yichong Zhang, Dianying Zhang. Postoperative complications after internal fixation of proximal humeral fractures: mechanical instability and blood supply injury mechanisms[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2026, 14(03): 185-190.

肱骨近端骨折是成人中常见的骨折类型,其术后并发症发生率居高不下,严重制约肩关节功能恢复与患者生活质量。目前临床对并发症的核心发生机制仍缺乏系统整合阐释。本文以张殿英教授提出的"支撑-牵张效应"与"悬臂-杠杆重建-不稳定"两大核心理论为框架,系统综述肱骨近端骨折钢板内固定术后并发症的力学与血供损伤机制。研究表明,术后并发症并非单一因素导致,而是力学失稳、血供破坏等多种因素共同作用的结果:内侧柱支撑缺失、复位不良引发力学失衡与应力集中,造成螺钉-骨界面失效与内固定疲劳断裂;软组织过度剥离、肱骨距损伤、骨折类型复杂等导致肱骨头血供受损,诱发缺血坏死;骨质疏松、骨微结构差异、螺钉置入位置与长度不当、钢板定位偏差进一步放大并发症风险。本文明确力学机制与血供损伤在并发症中的主导作用,为临床优化手术策略、强化内侧支撑、精准置钉、保护血运及制定个体化康复方案提供理论依据,希望对降低术后并发症发生率,提升肱骨近端骨折治疗效果有所帮助。

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