应用肱骨近端锁定钢板治疗肱骨近端骨折的临床结果分析

目的探讨应用肱骨近端锁定钢板（LPHP）治疗肱骨近端骨折的临床效果和适应证选择。方法2004年9月至2006年3月收治的84例肱骨近端骨折患者中75例患者获得随访,平均随访时间17个月（12—30个月）。新鲜骨折60例,陈旧骨折15例,均行切开复位LPHP内固定。应用美国肩肘外科医师评分（ASES）、Constant-Muxley评分、UCLA评分系统以及简易肩关节测验（SST）问卷评估治疗结果,观察肩关节活动范围,肌力、疼痛情况,并对比新鲜骨折与陈旧骨折的治疗效果。结果75例患者肩关节活动范围平均为前屈上举（147．3±17．7）°,外旋（30．5±16．2）°,内旋达Tq水平。ASES平均为86．7±12．7;Constant-Murley评分为87．4±10．5;UCLA评分系统为30．1±4．2,总体优良率为89．3％。与新鲜骨折相比,陈旧骨折患者前屈上举的范围和ASES评分存在明显差异（均为P〈0．05）。在9例出现晚期并发症的患者中ASES、UCLA、Constant-Murley评分与无并发症的患者相比均存在明显差异（P〈0．05）。结论正确选择手术指征和掌握操作技术,应用肱骨近端锁定钢板治疗存在明显移位的肱骨近端骨折可以获得较为满意的临床结果。

Clinical research on proximal humeral fractures treated by locking proximal humeral plate

OBJECTIVE: To evaluate the indications and clinical results of displaced proximal humeral fractures treated by locking proximal humeral plate (LPHP). METHODS: From September 2004 to March 2006, 75 patients which were treated by open reduction and internal fixation with LPHP were available to follow-up, with an average time of 17 months (12 - 30 months). There were 60 fresh fractures and 15 delayed fractures. The range of motion, muscle strength, visual analogue scale (VAS) for pain, American shoulder and elbow surgeon (ASES) score, Constant-Murley, University of California, Los Angeles (UCLA) scoring system and simple shoulder test (SST) for function evaluation were all recorded. RESULTS: The average forward flexion was (147.3 +/- 17.7) degrees , external rotation was (30.5 +/- 16.2) degrees and internal rotation was to T9. The mean ASES was 86.7 +/- 12.7, Constant-Murley was 87.4 +/- 10.5, UCLA was 30.1 +/- 4.2. The total good or excellent rate was 89.3%. Compare with fresh fractures, the delayed group showed significant less forward flexion and ASES (P = 0.021 and 0.036 respectively). In 9 patients with late complications, there were significant differences regarding ASES, UCLA scoring system and Constant-Murley compared with patients without any complication. CONCLUSION: With strict indication control and appropriate surgical technique, satisfactory results can be expected for the displaced proximal humeral fractures treated with locking proximal humeral plates.