肱骨近端锁定钢板治疗肱骨近端粉碎性骨折的中期随访研究

目的:探讨肱骨近端锁定钢板(locking plate of proximal humerus,LPHP)治疗肱骨近端粉碎性骨折的中期疗效,为临床应用提供依据。方法:总结2005年8月至2008年4月23例使用LPHP治疗的肱骨近端粉碎性骨折患者资料,男12例,女11例;年龄27～76岁,平均51.5岁;车祸伤18例,摔伤4例,重物压砸伤1例。Neer分型:三部分骨折11例,四部分骨折12例。14例植骨,其中6例自体髂骨植骨,7例人工骨植骨,1例自体髂骨加人工骨混合植骨。使用Constant-Murley(C-M)肩关节评分标准进行疗效评定。结果:术后所有患者切口Ⅰ期愈合,所有患者定期随访,分别在术后3、6和12个月,随访时间17～49个月,平均35.25个月。20例于术后4～7个月获得骨性愈合。术后3、6与12个月C-M肩关节评分比较,差异无统计学意义,术后12个月评分38～100分,平均(79.85±17.23)分,其中优8例,良8例,一般5例,差2例。LPHP加植骨组优6例,良4例,一般3例,差1例;单纯LPHP固定组优2例,良4例,一般2例,差1例。结论:LPHP治疗肱骨近端粉碎性骨折,中期疗效显著,对伴有骨质疏松及骨缺损的肱骨近端粉碎性骨折应常规植骨。

A medium term analysis on of therapeutic effects of locking proximal humerus plate for the treatment of comminuted fractures of proximal humerus

Objective: To investigate the medium-term curative effects of locking proximal humerus plate for the treatment of comminuted fractures of proximal humerus,and provide evidences for the clinical practice. Methods: From August 2005 and April 2008,23 patients with comminuted fractures of proximal humerus were treated with locking plates,including 12 males and 11 females,aged 27 to 76 years old (averaged 51.5 years old). There were 18 cases of traffic accident injuries,4 cases of falls injuries,and 1 case injured after heavy pressure. According to Neer classification,11 cases were three-part fractures,and 12 cases were four-part fractures. Outcomes were assessed with radiography and the Constant-Murley(C-M) shoulder evaluation. Results: All the patients got primary healing of incisions. Twenty-three patients were followed up,and the duration ranged from 17 to 49 months,with an average of 35.25 months. Twenty patients had fracture healing during 4 to 7 months after operation. There was no significant differences among 3,6 and 12 months after operation in C-M scoring. The average C-M score was(79.85±17.23) points(38 to 100 points) at the 12th month after operation,8 cases got an excellent result,8 good,5 fair,and 2 poor. In the LPHP plus bone graft group 6 cases got an excellent result,4 good,3 fair,and 1 poor; in LPHP fixation group 2 excellent,4 good,2 fair,and 1 poor. Conclusion: The medium-term curative effect of the locking proximal humerus plate in the treatment of proximal humeral fractures is significant. For the comminuted fractures of proximal humerus combined with osteoporosis and bone defects,bone graft should be performed routinely.