肱骨近端内固定锁室系统接骨板治疗肱骨近端外翻嵌插四部分骨折的疗效分析

目的 探讨利用AO肱骨近端内固定锁室系统(proximal humeral internal locking system,PHILOS)接骨板切开复位内固定治疗肱骨近端外翻嵌插四部分骨折的术后疗效.方法 对11例平均年龄42岁的肱骨近端外翻嵌插四部分骨折的患者进行手术治疗.术中注意保护小结节内侧的骨膜连续性,仅在结节间沟外侧进行显露,肱骨头复位后骨缺损处行自体骨或同种异体骨移植,PImDS接骨板板内固定.结果 经平均20个月的随访发现1例肱骨头坏死,坏死率为9.1%.肩关节平均前屈上举150°、外旋20°、内旋Th12,JOA评分平均91分.结论 利用PHILOS接骨板切开复位内固定治疗肱骨近端外翻嵌插四部分骨折取得了良好的疗效.

Early results for treatment of valgus impacted four-part proximal humerus fractures using the PHILOS plate system

Objective To evaluate the clinical results of open reduction and internal fixation of valgus impacted four-part proximal humerus fractures with the AO proximal humeral internal locking system (PHILOS). Methods Eleven patients (mean age 42 years) with four-part valgus impacted fracture of the proximal humerus underwent operations. The exposure was limited tothe lateral side of the intertubercular sulcus and the periosteal continuity of the lesser tubercle was preserved. When the humeral head was reduced, autograft or allograft bone was implanted to the site of bone defects, and subsequently the PHILOS plate was used to fix the fractured bone. Results All cases were followed up 20 months after the surgery. Avascular necrosis of the humeral head was found in one case. The necrosis ratio was 9.1%. The mean angle of anterior flexion of the shoulder was 150°. The mean angles of external and internal rotation of the shoulder were 20° and Thl2, respectively. The mean JOA score was 91. Conclusion Open reduction and internal fixation with PHILOS locking plate can gain satisfactory therapeutic effects in the treatment of valgus impacted four-part proximal humerus fractures.