骨科英文书籍精读（77）｜肱骨近端骨折（4）
THREE-PART FRACTURES
These usually involve displacement of the surgical neck and the greater tuberosity; they are extremely difficult to reduce closed. In active individuals this injury is best managed by open reduction and internal fixation. There is little evidence that one technique is better than another although the newer implants with locked plating and nailing are biomechanically superior in osteoporotic bone.
FOUR-PART FRACTURES
The surgical neck and both tuberosities are displaced. These are severe injuries with a high risk of complications such as vascular injury, brachial plexus damage, injuries of the chest wall and (later) avascular necrosis of the humeral head. The x-ray diagnosis is difficult (how many fragments are there, and are they displaced?). Often the most one can say is that there are ‘multiple displaced fragments’, sometimes together with glenohumeral dislocation. In young patients an attempt should be made at reconstruction. In older patients, closed treatment and attempts at open reduction and fixation can result in continuing pain and stiffness and additional surgical treatment can compromise the blood supply still further. If the fracture pattern is such that the blood-supply is likely to be compromised, or that reconstruction and internal fixation will be extremely difficult, then the treatment of choice is prosthetic replacement of the proximal humerus.
The results of hemiarthroplasty are somewhat unpredictable. Anatomical reduction, fixation and healing of the tuberosities are prerequisites for a satisfactory outcome; even then, secondary displacement of the tuberosities may result in a poor functional outcome. In addition the prosthetic implant should be perfectly positioned. Be warned – these are operations for the expert; the subject is well covered by Boileau et al. (2006).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
glenohumeral dislocation盂肱脱位
prosthetic replacement假体置换 /prɑːsˈθetɪk/adj. 假体的；非朊基的
The results of hemiarthroplasty are somewhat unpredictable. 半关节置换术的结果有些难以预测。
prerequisites 预备知识，先决条件（prerequisite复数） /ˌpriːˈrekwəzɪt/
百度翻译：
三部分骨折
这些通常涉及手术颈部的移位和更大的结节；它们极难减少闭合。在活跃的个体中，这种损伤最好通过开放复位和内固定来控制。几乎没有证据表明一种技术优于另一种技术，尽管具有锁定钢板和钉的新型植入物在骨质疏松骨中具有生物力学优势。
四部分骨折
手术颈部和两个结节都移位了。这些是严重的损伤，具有并发症的高风险，例如血管损伤，臂丛神经损伤，胸壁损伤和（后来）肱骨头缺血性坏死。x射线诊断很困难（有多少碎片，它们是否移位？）。通常最可以说的是存在“多个移位的碎片”，有时伴有盂肱关节脱位。在年轻患者中，应该尝试重建。在老年患者中，闭合治疗和开放复位和固定的尝试可导致持续的疼痛和僵硬，并且额外的手术治疗可进一步损害血液供应。如果骨折模式使得血液供应可能受损，或者重建和内固定将非常困难，则选择的治疗是假体置换肱骨近端。
半关节成形术的结果有些不可预测。结节的解剖复位，固定和愈合是获得满意结果的先决条件；即使如此，结节的二次移位也可能导致不良的功能结果。此外，假体植入物应完全定位。受到警告–这些都是专家的操作；Boileau等人对此主题进行了很好的介绍。（2006年）。