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中华老年骨科与康复电子杂志 ›› 2026, Vol. 12 ›› Issue (04) : 219 -225. doi: 10.3877/cma.j.issn.2096-0263.2026.04.004

肩肘专题

切开复位内固定治疗肱骨头劈裂骨折的疗效分析
高英健, 岳冰, 信维伟†()   
  1. 200127 上海交通大学医学院附属仁济医院骨关节外科
  • 收稿日期:2025-06-25 出版日期:2026-08-05
  • 通信作者: 信维伟
  • 基金资助:
    国家杰出青年科学基金(82225031)

Analysis of ORIF Efficacy in Humeral Head Split Fractures

Yingjian Gao, Bing Yue, Weiwei Xin†()   

  1. Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
  • Received:2025-06-25 Published:2026-08-05
  • Corresponding author: Weiwei Xin
引用本文:

高英健, 岳冰, 信维伟. 切开复位内固定治疗肱骨头劈裂骨折的疗效分析[J/OL]. 中华老年骨科与康复电子杂志, 2026, 12(04): 219-225.

Yingjian Gao, Bing Yue, Weiwei Xin. Analysis of ORIF Efficacy in Humeral Head Split Fractures[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2026, 12(04): 219-225.

目的

探讨切开复位内固定术(ORIF)治疗肱骨头劈裂骨折的临床疗效。

方法

回顾性分析2017年7月至2023年2月收治的7例肱骨头劈裂骨折患者(累及关节面>20%,移位>2 mm或成角>20°),均采用ORIF治疗:经上2/3肩胛下肌剥离、冈上肌-冈下肌间隙入路显露骨折,埋头螺钉固定关节面骨折块后锁定钢板整体固定。术后平均随访33.4个月,评估Constant评分、ASES评分等功能指标及并发症。

结果

末次随访功能评分良好[校正Constant评分(75.4±8.6)分,ASES评分(88.4±7.2)分]。患侧外展肌力较健侧显著减弱[术侧:(51±5.1)N vs.非术侧:(79±17)N;P=0.002],但内旋肌力无差异(P=0.96)。其中一例患者关节面复位不良,一例患者出现肱骨头坏死。

结论

ORIF技术可实现肱骨头劈裂骨折的解剖复位与稳定固定,为年龄<65岁患者提供良好中期功能预后,且潜在降低骨坏死风险,但外展肌力恢复需重点关注。

Objective

To investigate the clinical efficacy of ORIF for treating humeral head split fractures.

Methods

A retrospective analysis was conducted on seven patients with humeral head split fractures involving >20% of the articular surface, with displacement of >2 mm or angulation of >20°, who were treated between July 2017 and February 2023. All patients underwent ORIF. Fracture exposure was achieved via a superior two-thirds subscapularis tenotomy and an interval approach between the supraspinatus and infraspinatus muscles. The articular fracture fragments were fixed with countersunk screws, followed by definitive fixation using a locking plate. Postoperative follow-up averaged 33.4 months. Functional outcomes were assessed using the Constant and ASES (American Shoulder and Elbow Surgeons) scores. Complications were recorded.

Results

At the final follow-up, the functional scores were favourable (adjusted Constant score: 75.4±8.6; ASES score: 88.4±7.2). However, abduction strength was significantly weaker on the surgical side than on the non-surgical side (surgical side: 51±5.1 vs. non-surgical side: 79±17; P=0.002). However, no significant difference was found in internal rotation strength (P=0.96). One patient experienced malreduction of the articular surface and one patient developed humeral head osteonecrosis.

Conclusion

Open reduction and internal fixation (ORIF) enables anatomical reduction and stable fixation of humeral head split fractures, providing good mid-term functional outcomes for patients aged under 65 years and potentially reducing the risk of osteonecrosis. However, specific attention to restoring abduction strength is warranted.

图1 患者,男,46岁,因肱骨头劈裂骨折行内固定术,(a、b、c)术前影像;(d、e)术后摄片;(f、g、h、i)右肱骨头劈裂骨折术后54月肩关节功能;红色箭头所指骨折线位置;绿色箭头所指内固定位置
图2 患者,男,31岁,因肱骨头劈裂骨折行内固定术,(a、b、c)术前影像;(d、e)术后摄片;(f、g、h、i)右肱骨头劈裂骨折术后30月肩关节功能;红色箭头所指骨折线位置;绿色箭头所指内固定位置
表1 肱骨头劈裂骨折患者及临床数据
表2 肱骨头劈裂骨折患者末次随访功能评分及活动度
表3 肱骨头劈裂骨折患者末次随访肌力比较(牛顿,N,术侧vs.非术侧)
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