Functional outcome following proximal humeral interlocking system plating for displaced proximal humeral fractures

Aim:

To assess the functional outcome following internal fixation with the PHILOS (proximal humeral interlocking system) for displaced proximal humeral fractures.

Patients and Methods:

We reviewed 30 consecutive patients treated surgically with the proximal humeral locking plate for a displaced proximal humeral fracture. Functional outcome was determined using the American Shoulder and Elbow Society (ASES) score and Constant Murley score.

Results:

Average age of the patients was 58 years (range, 19-92 years). The average overall ASES score was 66.5. The average overall Constant score was 57.5.

Conclusion:

Our results show that good fracture stability was achieved, and the functional outcome was very good in younger patients and it declined with increasing age. Early mobilization of the shoulder can be achieved without compromising fracture union.     

Mid-term results of internal fixation of proximal humeral fractures with the Philos plate

Objective

To report our experience from the use of the Philos^® plate for the treatment of three- and four-part proximal humeral fractures and to investigate factors influencing the final outcome.

Materials and methods

Between April 2005 and September 2007, 29 Philos plates were implanted in 17 women and 12 men, with a mean age of 62.3 years (range: 28–80 years). Positioning of the plate was performed under fluoroscopic control, through a deltopectoral approach and with the patient in the beach chair position. 27 patients were available for follow-up (mean: 17.9 months; range: 12–39). Follow-up included plain shoulder radiographs and functional assessment with Constant–Murley score.

Results

Healing of the fracture occurred uneventfully within 6 months. In three patients, humeral head collapsed due to aseptic necrosis after fracture healing and the plate had to be removed in two cases. In one patient, fracture healing occurred in >10° varus displacement. The clinical result according to the Constant–Murley score was 86 points (range: 58–112).

Conclusions

Internal fixation with the Philos plate seems to be a reliable option in the operative treatment of upper end humeral fractures, especially in osteoporotic bone. It allows secure fracture fixation and quick shoulder mobilisation, while quick and uneventful fracture healing and very satisfactory clinical results are achieved.     

PHILOS钢板在肱骨近端骨折治疗中的应用

目的 探讨PHILOS钢板治疗肱骨近端骨折的疗效.方法采用PHILOS钢板治疗34例肱骨近端骨折患者.结果 失访6例,28例获得随访,时间2～24个月.患者均获得骨性愈合.术后12个月按Constant-Murley评分标准评定临床疗效：优9例,良16例,可3例.结论 PHILOS钢板内固定治疗肱骨近端骨折,手术创伤小,骨折愈合快,肩关节功能恢复良好,是治疗肱骨近端骨折特别是合并骨质疏松患者的理想术式.     

微创技术置入PHILOS钢板治疗肱骨干近端骨折

目的评价微创接骨板固定(MIPO)技术置入PHILOS(proximal humeral internal locking system)治疗肱骨干近端骨折的临床效果。方法自2008年11月~2009年8月,采用MIPO技术置入PHILOS钢板治疗23例肱骨干近端移位骨折。结果本组获随访6～17个月,平均11.3个月。X线片示22例于术后6个月内骨折达骨性愈合;1例因内固定松动发生延迟愈合,但无临床症状,于术后9个月骨折愈合,功能恢复至可。术后半年1例发生肩关节撞击征,取出内固定行功能锻炼后功能恢复至可。采用Constant-Murley评分方法评定疗效:优11例,良10例,可2例,优良率91.3%。结论采用MIPO技术置入PHILOS钢板治疗肱骨近端骨折是一种良好的方法,减少骨不连发生率,有利于肩关节早期功能恢复。     

锁定加压钢板内固定治疗肱骨近端骨折

目的探讨锁定加压钢板治疗肱骨近端骨折的疗效。方法回顾分析2002年2月-2007年7月应用锁定加压钢板内固定治疗肱骨近端骨折39例。结果本组病人39例都得到随访,随访时间平均9个月,优良率87．2％。结论锁定加压钢板内固定是治疗肱骨近端骨折较理想的一种手术方法。     

锁定接骨板治疗老年肱骨近端骨折

目的探讨肱骨近端锁定接骨板内固定治疗老年肱骨近端骨折的疗效。方法2002年1月～2004年1月对35例老年肱骨近端骨折予以锁定接骨板内固定治疗,术后早期功能锻炼。结果术后所有患者平均随访13.2个月,骨折愈合时间平均8.3周(7～12周),1例肱骨头缺血性坏死。按Constant评分标准,平均81.4分(39～95分),其中优22例,良8例,中4例,差1例,优良率85.7%。结论肱骨近端锁定接骨板对于骨质疏松的老年肱骨近端骨折是一种安全有效的治疗方法。     

Internal fixation of proximal humeral fractures with a Polarus humeral nail

Background  Proximal humeral fractures occur frequently. Displaced or unstable fractures require open reduction and internal fixation. Our objective was to investigate the clinical and radiographic results of the internal fixation using Polarus humeral nails for fractures of the proximal humerus. Materials and methods  From January 2001 to April 2006, 54 shoulders of 54 patients (44 females, 10 males) underwent the intramedullary fixation using Polarus humeral nail. Mean age of the patients was 66-year-old (39–89) at the time of the surgery. Fracture-type by Neer classification was 2-part (29 shoulders), 3-part (22 shoulders) and 4-part (3 shoulders). The clinical and radiological outcomes were evaluated. Results  All the shoulders after osteosynthesis obtained bone-union. There was no osteonecrosis of the humeral head. Functional outcome measured by JOA score averaged 81 points. Totally 43 patients (79%) had satisfactory to excellent results. Varus deformity was seen in 4 shoulders (8%) and the deformity of the greater tuberosity in 4 (8%). Conclusion  The Polarus intramedullary humeral nail is effective for the treatment of proximal humeral fractures.     

双钢板固定治疗老年复杂肱骨近端骨折

目的：探讨前内侧联合外侧锁定钢板治疗老年复杂肱骨近端骨折的疗效。方法 ：2018年6月至2020年10月,分别采用前内侧联合外侧锁定钢板（anteromedial combined with lateral locking plate,ALLP）及单纯肱骨近端锁定钢板（proximal humerus locking plates,PHLP）治疗各15例Neer 3、4部分肱骨近端骨折患者。其中男8例,女22例;年龄51～78 (61.5±7.5)岁。分为ALLP组和PHLP组。比较两组患者的临床资料与术后简明肩关节功能评分（simple shoulder test,SST）、肱骨头高度丢失值、内翻角及肩关节活动度。结果：所有骨折获骨性愈合。随访时间12～24 (14.3±2.9)个月。ALLP组手术时间较PHLP组长（P<0.05）。两组术中出血量比较差异无统计学意义（P>0.05）。术后1、3、12个月两组SST评分差异无统计学意义（P>0.05）。影像学测量方面,术后1、3个月,两组肱骨头高度丢失值及内翻角差异无统计学意义（P>0.05）;术后12个月时,...     

二、三部分肱骨近端移位骨折的手术治疗

目的探讨二、三部分肱骨近端移位骨折的手术治疗方法。方法肱骨近端移位骨折29例,二部分骨折22例,三部分骨折7例,闭合复位经皮克氏针固定7例,切开复位,不可吸收缝线固定1例,单纯螺钉固定6例,普通4孔钢板固定3例,张力带固定2例,髓内针张力带固定5例,“T”钢板固定5例。结果平均随访18月,采用Neer分类及评分对各手术疗效进行评价。其中二部分骨折优良率为72.7%,未出现骨折不愈合及肱骨头坏死;三部分骨折优良率为42.9%,肱骨头坏死率28.6%。结论二、三部分骨折尽量采用有限切开复位,其中二部分骨折可选择单纯螺钉、张力带或髓内针张力带固定,三部分骨折可选择髓内针张力带固定。     

切开复位内固定治疗肱骨近端三、四部分骨折

目的 观察切开复位内固定治疗肱骨近端三、四部分骨折的疗效。方法 37例肱骨近端三、四部分骨折采用切开复位内固定治疗。内固定方法包括AOT形钢板21例、Neer双张力带钢丝9例、AOT形钢板 Neer双张力带钢丝7例。术后按美国肩肘关节医师学会的肩关节评分系统进行疗效评估。结果 术后患肩基本无痛或轻微疼痛。比较健侧肩关节功能评分,患肩平均上举幅度恢复至健侧的75.35％,内旋恢复至71.38％,外旋恢复至70.79％,完成7项日常生活动作能力恢复至健侧的83.48％。显示总体疗效良好。结论 AOT型钢板适用于骨质条件好,肱骨头关节端骨块骨量多,肱骨大、小结节骨片较大,肱骨干骺端较粉碎的患者。反之则以Neer双张力带钢丝为佳。对骨质疏松,肱骨头关节端骨块骨量少,肱骨干骺端粉碎伴骨缺损患者,干骺端结构性植骨后,则联合使用两方法。     

锁定钢板与常规手术治疗肱骨近端骨折疗效比较

目的 :比较肱骨近端锁定钢板 (LockingProximalHumerusPlate)与常规手术方法治疗肱骨近端骨折疗效。方法 :回顾性分析比较肱骨近端锁定钢板治疗肱骨近端骨折与常规手术方法的疗效与并发症。结果 :锁定钢板治疗组的疗效及并发症发生率明显优于常规手术方法组 ,治疗组的满意率 87.5 %～ 76% ,断钉断板率 <16% ,感染率 <8% ,肩峰撞击 <2 0 % ,四部分骨折肱骨头坏死率 3 3 .3 %～ 60 % ,P <0 .0 5。结论 :治疗肱骨近端骨折方法多样 ,肱骨近端锁定钢板是一种创新、优异的方法。     

PHILOS钢板和Multiloc髓内钉治疗老年肱骨近端骨折的显性失血和隐性失血分析

目的分析PHILOS钢板和Multiloc髓内钉治疗老年肱骨近端骨折的显性失血和隐性失血的临床特点。 方法回顾性分析2016年1月至2019年12月分别采用PHILOS钢板治疗（45例）和Multiloc髓内钉治疗（37例）的老年肱骨近端骨折患者的临床资料,比较手术时间、显性失血量和隐性失血量,对患者围手术期失血情况进行评估和分析。 结果PHILOS钢板组平均手术时间（141.78±36.18）min,总失血量674.68（592.87,979.65）ml,显性失血量320.00（220.00,430.00）ml;Multiloc髓内钉组平均手术时间（102.70±22.10）min,总失血量589.23（430.80,714.82）ml,显性失血量100.00（100.00,125.00）ml,两组间差异具有统计学意义（P<0.05）。两组围手术期隐性失血量为383.55（253.17,575.48）ml和460.98（309.87,610.25）ml,差异无统计学意义（P>0.05）,分别占总失血量56.85%和78.23%。 结论与PHILOS钢板比较,Multiloc髓内钉内固定治疗此类骨折患者的平均手术时间短,总失血量和显性失血量少。两种内固定治疗方式的隐性失血量无明显差异,但隐性失血量在总失血量中所占比重较大,临床上应该时刻重视,积极干预,改善患者预后。     

三叶草钢板内固定治疗肱骨近端骨折

1999～2005年,我院应用三叶草钢板内固定治疗肱骨近端骨折32例,疗效满意。     

内固定与肱骨头置换治疗高龄肱骨近端骨折比较

[目的]比较切开复位解剖锁定钢板内固定术(locking proximal humeral plate,LPHP)与肱骨头置换(humeral hemiar-throplasty,HHA)治疗高龄患者复杂肱骨近端骨折的临床疗效.[方法]回顾性分析2015年1月-2018年1月,手术治疗78例高龄(≥80岁)复杂肱骨近端...     

手术治疗移位肱骨近端骨折

2000年3月～2005年1月,我科采用手术治疗移位肱骨近端骨折51例,临床疗效满意。     

锁定钢板内固定治疗高龄患者肱骨近端骨折

正2011年4月~2014年9月,我科采用锁定钢板内固定治疗17例高龄肱骨近端骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组17例,男7例,女10例,年龄70~84岁。均为新鲜骨折,伴肩关节脱位4例。按肱骨近端骨折Neer分型:Ⅲ型6例,Ⅳ型11例。1.2治疗方法臂丛麻醉或全身麻醉。     

A prospective study of a new locking plate for proximal humeral fracture

Displaced and unstable extra-articular fractures of the proximal humerus are treated by operative reduction and fixation using various techniques such as fixed plates and intramedullary implants. This prospective study evaluates the clinical efficacy of a novel implant that is attached to the humeral head with fixed-angle locking screws. Between October 2002 and November 2005, 99 people (mean age 62.8 years) with proximal humeral fractures received treatment involving this plate in our department. The mean follow-up time was 17.8 months. Outcome was assessed with radiography, the Constant-Murley (C-M) shoulder evaluation and the Disabilities of the Arm, Shoulder and Hand (DASH) score. The mean C-M score was 64.95% and the mean DASH score was 30.1 points. Outcome was judged excellent in 51%, good in 19%, moderate in 19% and poor in 11% of cases.     

锁定钢板结合异体腓骨治疗头内翻型肱骨近端骨折

目的探讨锁定钢板结合异体腓骨治疗头内翻型肱骨近端骨折的临床疗效。 方法回顾性分析2013年6月至2015年6月安徽医科大学第二附属医院采用PHILOS锁定钢板固定治疗35例头内翻型肱骨近端骨折患者资料（术前颈干角<130°）,按术中是否采用异体腓骨来加强内侧支撑分为两组,锁定钢板结合异体腓骨组与单纯锁定钢板组。锁定钢板结合异体腓骨组共11例,男6例、女5例,年龄为（60.27±12.32）岁;单纯锁定钢板组共24例,男10例、女14例,年龄为（50.21±17.60）岁。两组患者资料在基线水平差异均无统计学意义（P>0.05）。根据术后影像学资料评估颈干角,并计算术后1年与术后第1天颈干角的差值,应用术后1年随访时Constant-Murley评分及臂、肩、手功能障碍评分（disabilities of the arm, shoulder and hand score,DASH）评估患者肩关节功能。应用统计学比较两组术前基线水平（年龄、性别、骨折分型、是否抽烟、优势手及内侧柱是否粉碎）是否有差异,再比较术后1年两组颈干角差值及Constant-Murley评分是否有差异。 结果术后1年锁定钢板结合异体腓骨组颈干角改变（-1.36±2.58）°,单纯锁定钢板组改变（-7.21±8.06）°,差异具有统计学意义（P=0.003）。术后1年锁定钢板结合异体腓骨组Constant-Murley评分（76.82±6.11）分,单纯锁定钢板组为（64.29±9.15）分,差异具有统计学意义（P=0.0002）。锁定钢板结合异体腓骨组DASH评分（15.55±2.98）分,单纯锁定钢板组为（25.96±9.35）分,差异具有统计学意义（P=0.001）。其中锁定钢板结合异体腓骨组有1例患者出现术后切口感染;单纯锁定钢板组有3例患者出现螺钉穿出,1例患者出现肱骨头缺血坏死。 结论在治疗头内翻型肱骨近端骨折方面,锁定钢板结合异体腓骨能有效地增加术后骨折块的稳定性,减少术后颈干角的改变,提高术后的肩关节功能。