两种锁定钢板置入内固定治疗老年肱骨近端骨折

背景：肱骨近端内固定锁定系统（proximal humeral internal locking system，PHILOS）和肱骨近端锁定钢板（locking proximal humerus plate，LPHP）均作为内固定锁定钢板，用于治疗肱骨近端骨折疗效显著，但目前尚不能肯定PHILOS和LPHP治疗老年肱骨近端骨折哪个更具优势？目的：探讨比较PHILOS和 LPHP这两种锁定板治疗老年肱骨近端骨折的近期疗效。方法：回顾性分析具有完整随访资料的61例老年肱骨近端骨折患者，根据不同治疗方法分为 LPHP 治疗组（n=27）和PHILOS治疗组（n=34）。均根据Neer分类，LPHP组二部分骨折7例，三部分骨折11例，四部分骨折9例；PHILOS组二部分骨折9例，三部分骨折14例，四部分骨折11例。记录手术时间、出血量、引流量，观察骨折愈合时间、功能恢复、并发症，并进行统计学分析。结果与结论：61例患者全部获得随访，随访时间12-36个月（平均20.6个月），PHILOS组和LPHP组手术时间、出血量、引流量，观察骨折愈合时间、功能恢复、并发症比较，差异并无显著性意义（P〉0.05）。PHILOS和LPHP治疗老年肱骨近端骨折均可获得良好的效果，随访1年时优良率分别为81.5%，82.4%；具有固定可靠、并发症少、满意率高等优点，两种锁定板目前具有较高的临床应用价值，是治疗移位和不稳定老年肱骨近端骨折有效的切开复位内置物。

Two kinds of locking plate for treatment of proximal humerus fractures in the elderly

BACKGROUND：Proximal humeral internal locking system （PHILOS） and locking proximal humerus plate （LPHP） are both new types of internal fixation plates, and have satisfactory effects in the treatment of proximal humerus fractures. However, which is better？ OBJECTIVE：To compare the short-term efficacy of PHILOS and LPHP in the treatment of elderly patients with proximal humeral fractures. METHODS：The fol ow-up data of 61 elderly patients with proximal humeral fractures were retrospectively analyzed. The patients were divided into PHILOS group （n=34） and LPHP group （n=27）. According to the Neer system, there were two parts of fractures in seven cases, three parts of fractures in 11 cases, four parts of fractures in nine cases in LPHP group;there were two parts of fractures in nine cases, three parts of fractures in 14 cases, four parts of fractures in 11 cases in PHILOS group. The operation time, blood loss, and drainage volume were recorded. The time of fracture healing, functional recovery, and complications were observed. Statistical analysis was performed. RESULTS AND CONCLUSION：Al 61 patients were fol owed up for 12-36 months （mean 20.6 months）. There was no statistical difference in operation time, blood loss, drainage volume, time of fracture healing, functional recovery and complications between the two groups （P〉0.05）. Both LPHP and PHILOS groups could obtain good effects in treatment of senile proximal humeral fractures. The excellent and good rate was respectively 81.5%and 82.4%in two groups. They have advantages of reliable fixation, few complications, and high satisfaction rate. Currently these locking plates have a high clinical value and can be considered as useful implants for ORIF of displaced and unstable proximal humeral fractures.