锁定接骨板治疗肱骨近端三、四部分骨折

背景：锁定接骨板是一种新型的内固定钢板,可以改善肱骨近端骨折的临床治疗效果。目的：探讨锁定接骨板置入内固定治疗肱骨近端三、四部分骨折疗效以及并发症的发生情况。方法：回顾性分析复旦大学附属中山医院青浦分院骨科2008年1月至2009年12月行锁定接骨板内固定治疗31例肱骨近端骨折患者临床资料,其中男13例,女18例;年龄28-81岁,平均56.4岁。骨折类型采用Neer分类,三部分骨折19例,四部分骨折12例。内固定治疗采用胸大肌三角肌间沟入路,行肱骨近端锁定接骨板内固定术。另外,检索锁定接骨板治疗肱骨近端三、四部分骨折并发症的相关研究文献,对并发症的发生情况进行研究分析。综合分析临床病例疗效与检索文献中并发症的发生情况,获得锁定接骨板治疗肱骨近端三、四部分骨折的特点。结果与结论：复旦大学附属中山医院青浦分院骨科应用锁定接骨板内固定治疗31例患者均得到13-49个月随访,平均随访19.8个月。骨折均愈合,无内固定失效,临床愈合时间为8-16周。根据Constant评分标准评定肩关节功能,其中优11例,良16例,可3例,差1例。锁定接骨板内固定是治疗肱骨近端三、四部分骨折可靠有效的方法。但也可发生螺钉松动、肱骨头坏死等相关并发症,因此,内固定治疗操作时应注意保护肱骨头血运,复位肱骨颈内侧骨折块并牢固固定,以减少并发症的发生,提高内固定治疗疗效。

Locking plate for the treatment of 3-part and 4-part fracture of proximal humerus

BACKGROUND： The locking plate is a new type of internal fixation plates which can improve the clinical treatment effect of proximal humeral fractures.OBJECTIVE： To explore the effect of locking plate fixation for the treatment of 3-part and 4-part fracture of proximal humerus, and to explore the incidence of complications.METHODS： Thirty-one proximal humeral fracture patients （13 males and 18 females, aged from 28 years to 81 years, averaged in 56.4 years） treated with locking plate fixation were selected from Department of Orthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University between January 2008 and December 2009. The clinical data of the 31 patients was retrospectively analyzed. The type of fracture was classified with Neer classification, and found that 19 patients had 3-part fracture and 12 patients had 4-part fracture. The internal fixation was performed with pectoralis major deltoid interscalene approach and then the proximal humeral locking plate fixation was performed. The literatures on the locking plate for the treatment of 3-part and 4-part fracture of proximal humerus were searched to analyze the incidence of complications. The efficacy of clinical cases and in the incidence of complications the retrieved documents were comprehensively analyzed, and the features of locking plate for the treatment of 3-part and 4-part fracture of proximal humerus were obtained.RESULTS AND CONCLUSION： All the 31 patients mentioned above were followed-up for 13-49 months, average in 19.8 months. The fracture of all the patients were healed without fixation failure and the clinical healing time was 8-16 months. The shoulder function was assessed according to the Constant assessment criteria, and found that excellent in 11 patients, good in 16 patients, average in 3 patients and poor in 1 patient. Locking plate fixation is the reliable and effective method for the treatment of 3-part and 4-part fracture of proximal humerus. But the screw loosening, humeral head necrosis and other related complications may also occur. Therefore, we should pay attention to protect the blood supply of the humeral head during fixation and reset the medial humeral neck fracture and firmly fixed, in order to reduce the complications and improve the treatment effect of fixation.