LCP钢板在肱骨近端骨折临床治疗中的应用

目的探讨应用LCP(locking-compression plate)在治疗肱骨近端骨折中临床应用疗效。方法对收治的16例肱骨近端骨折患者,Neer分类,均采用切开复位LCP钢板内固定,部分病例进行植骨。术后均定期门诊随访,并评定其疗效。结果随访时间为6～18个月,平均12.3个月,骨折均愈合,功能评定采用Neer评分,优良率为93.7%。结论肱骨近端LCP具有创伤小、骨折固定牢靠、功能恢复良好等优点,能用于治疗大部分类型的肱骨近端骨折。     

AO锁定钢板治疗肱骨近端骨折

目的分析采用切开复位AO锁定钢板内固定治疗肱骨近端骨折的治疗方法和疗效。方法回顾性分析本院2006年至2011年2月31例肱骨近端骨折患者的临床资料。骨折按Neer分型：2部骨折19例,3部骨折9例,4部骨折3例。所有病例均采用切开复位AO锁定钢板内固定治疗。结果31例病例随访8～36个月,平均（14．7±5．1）个月;按Neer疗效评分方法,优23例,良5例,中3例,差0例,优良率90_3％。结论切开复位AO锁定钢板内固定治疗肱骨近端骨折能使骨折解剖复位,有利于早期功能锻炼,有助于肩部功能恢复,是治疗肱骨近端骨折的一种有效方法。     

有限切开锁定加压钢板内固定加异体骨植入治疗复杂性肱骨干骨折

目的 介绍有限切开锁定加压钢板内固定加异体骨植入治疗复杂性肱骨干骨折的临床疗效.方法 2005年1月至2008年2月,应用有限切开AO锁定加压钢板(locking compression plate,LCP)加异体骨植入治疗复杂性肱骨干骨折15例,均为粉碎性骨折;按AO分类:属C型骨折,其中2例为肱骨干骨折伴有同侧肱骨近端骨折,5例骨折线延伸至肱骨近端.结果 所有患者伤口均Ⅰ期愈合.术后随访6～40个月,平均21.6个月,骨折愈合时间为12～36周,平均22.5周.2例发生医源性桡神经损伤(占13.3％),与原有的3例桡神经损伤均于术后3个月内完全恢复.肩、肘关节功能恢复良好.结论 有限切开锁定加压钢板内固定加异体骨植入是治疗复杂性肱骨干骨折的一种安全、有效的方法.     

MIPPO技术LCP钢板内固定治疗老年肱骨近端骨折

目的　选择小切口经皮插入钢板内固定技术 (MIPPO) ,应用LCP治疗老年肱骨近端骨折。方法　自 2 0 0 3年 9月以来 ,共施行MIPPO技术LCP钢板内固定治疗老年肱骨近端骨折 9例 ,手术方法为在肩峰下 1～ 2cm作一长约 5cm的横切口 ,分开三角肌 ,C型臂X线机下手法复位 ,沿骨膜表面顺行插入 7孔LCP钢板 ,于钢板远端作一长约 3cm纵行切口 ,分别于钢板近、远端上 4、 3枚自攻自钻锁定螺钉 ,次日开始功能锻炼。结果　骨折均于术后 3～ 4个月愈合 ,无出现感染、骨不连。术后功能按Neer评分 :优 2例 ,良 5例 ,可 2例。平均分数 :72 96± 5 6 2分。结论　小切口LCP钢板插入内固定 ,是治疗老年肱骨近端骨折一种新的选择     

应用肱骨近端锁定型钢板治疗肱骨近端骨折的回顾性研究

目的 探讨AO Philos钢板治疗肱骨近端骨折手术体会.方法 回顾性分析2006年7月-2009年5月应用AO Philos钢板治疗肱骨近端骨折29例,按Neer分型2部分骨折11例,3部分骨折16例,4部分骨折2例.结果 29例患者均获得随访,时间9～16个月,平均11.3个月,功能评定采用肩关节Neer功能评分标准:优13例,良12例,可4例,优良率86.2%.结论 AO Philos钢板治疗肱骨近端骨折具有手术创伤小,固定有效可靠,允许早期功能锻炼,疗效确切.     

LCP钢板治疗老年肱骨近端复杂骨折

[目的]分析老年肱骨近端复杂骨折的特点以及研究和探讨运用LCP钢板治疗老年肱骨近端复杂骨折的方法和评定疗效。[方法]2004年10月～2006年6月本院骨科收治老年肱骨近端复杂骨折16例,均采用切开复位LCP钢板内固定,术后均定期门诊随访,并评定其疗效。[结果]16例病人术后均获得门诊随访,随访时间为6～18个月,平均12.3个月,骨折均已愈合,功能评定采用Neer评分,优11例,良2例,可2例,差1例,总优良率为81.3%。X线检查复位结果,解剖复位6例,近似解剖复位6例,3例复位可,1例差。[结论]运用LCP钢板治疗老年肱骨近端复杂骨折具有创伤少、骨折固定牢靠、功能恢复良好等优点,目前仍然是一种对老年肱骨近端复杂骨折比较理想的治疗方式。     

微创股骨近端锁定加压钢板治疗老年股骨粗隆间骨折

目的探讨微创锁定加压钢板(LCP)治疗老年股骨粗隆间骨折的疗效。方法应用股骨近端LCP内固定治疗老年股骨粗隆间骨折21例,骨折按AO分类:A1型8例,A2型9例,A3型4例。结果切口长度4～6cm,手术时间40～75min,术中出血50～200ml。21例获3～14个月随访,骨折愈合时间2～4个月,无髋内翻、骨不连和内固定失效。结论微创股骨近端LCP治疗老年股骨粗隆间骨折创伤小,固定可靠,有利于老年患者全身状况和肢体功能恢复。     

锁定肱骨近端接骨板治疗肱骨近端骨折

目的探讨锁定肱骨近端接骨板治疗肱骨近端骨折的临床价值：方法采用切开复位AO锁定肱骨近端接骨板(LPHP)内固定治疗肱骨近端骨折12例。结果所有患随访3～13个月，平均7．5个月。临床疗效评估：优7例，良3例，进步2例，优良率为83．3％。结论LPHP具有固定可靠、减少软组织损伤、保护血运、利于关节囊和肩袖修复、有助于骨折愈合和肩关节功能恢复的特点，值得提倡。     

肱骨近端解剖型锁定加压钢板治疗肱骨头颈部骨折初步报告

目的探讨AO肱骨近端解剖型锁定加压钢板治疗肱骨头颈部骨折的疗效。方法9例肱骨头颈部骨折患者,分别采用AO解剖型锁定钢板内固定,术后早期功能锻炼。结果术后所有患者随访8～12个月,平均11.5个月,优良率为88.9%。结论解剖型锁定钢板内固定治疗肱骨头颈部骨折内固定坚强,有利于早期功能活动,减少关节粘连,促进功能恢复。     

肱骨近端锁定接骨板(LPHP)治疗肱骨近端骨折

目的探讨应用肱骨近端锁定接骨板(LPHP)治疗肱骨近端骨折的临床疗效。方法应用AO/ASIF的LPHP内固定治疗32例肱骨近端骨折患者,根据Neer分类:II型8例,III型17例,IV型7例。结果32例随访3～18个月,平均12.5个月,均达到骨性愈合,平均愈合时间为7.5周。根据Neer功能评分:优24例,良6例,中1例,差1例,优良率为93.8%。结论LPHP固定具有手术操作简便、固定稳定、血运破坏少、骨折愈合与功能恢复好等优点,是治疗肱骨近端骨折的良好方法。     

肱骨近端锁定钢板与传统AO钢板治疗老年肱骨近端骨折的比较

目的比较肱骨近端锁定钢板与传统AO钢板治疗老年肱骨近端骨折的疗效。方法2002年7月-2005年5月间收治37例老年肱骨近端骨折患者,采用肱骨近端锁定钢板(LPPH)治疗18例,年龄65-82岁(平均69岁),Neer分型三部分骨折12例,四部分骨折6例;采用传统AO钢板治疗19例,年龄65-84岁(平均71岁),Neer分型三部分骨折12例,四部分骨折7例。术后肩关节功能评估采用肩关节疼痛和功能障碍指数(SPADI)量表评分,对两组疗效进行比较。结果术后6周、12周、1年随访肩关节功能、骨折愈合及肱骨头坏死情况,发现LPPH治疗组的钢板螺丝钉松动发生率、术后肩关节评分均优于传统AO钢板治疗组。结论LPPH治疗老年骨质疏松患者的肱骨近端骨折相比传统AO钢板有明显的优势。     

斜T形锁定加压接骨板治疗桡骨远端骨折的临床研究

目的 探讨应用锁定加压接骨板(locking-compression plate，LCP)治疗桡骨远端骨折的可行性及临床应用价值。方法 对按AO分类为B型和C型的桡骨远端骨折病人19例，按AO内固定原则并根据桡骨的解剖外形，使用纯钛斜T形LCP行内固定治疗。结果 术后随访6-10个月，采用腕关节功能及X线片测量指标进行综合评定，优17例、良2例，总优良率为100％。结论 采用斜T形LCP能够用于治疗B、C类型的桡骨远端骨折，术中副损伤少，血运破坏小。尤其对于不稳定的、难治性的骨质疏松性的桡骨远端骨折具有良好的治疗效果，能够牢固维持术中恢复的解剖形状，有利于患肢早期的功能锻炼。     

锁定加压钢板治疗股骨转子间骨折

目的探讨和总结锁定钢板治疗股骨转子间骨折的疗效。方法自2005年6月至2008年2月应用锁定加压钢板治疗股骨转子间骨折28例,按AO分类,A 1型10例,A 2型7例,A 3型11例。结果术后随访6～20个月,平均11个月。参照黄公怡评分标准进行评价,优14例,良12例,差2例,优良率为92.7%。1例髋内翻畸形25°,1例畸形愈合伴下肢短缩2.5 cm。结论锁定加压钢板组合使用常规和锁定螺丝钉内固定方法,是治疗股骨转子间骨折的优良方法,尤其适用于粉碎性骨折和骨质疏松患者。     

锁定钢板治疗肱骨近端复杂骨折

目的：探讨锁定钢板治疗肱骨近端复杂骨折的临床疗效。方法：自2001年12月～2002年11月，14例肱骨近端复杂骨折按AO分类：11A3型2例，1181型1例，B2型5例，B3型4例，11C1型1例，C2型1例，经切开复位AO锁定钢板内固定治疗。结果：经6～15个月随访，无1例发生内固定松动、断裂，全部骨折均愈合。肩关节功能恢复优良率92．8％。结论：锁定钢板具有高度稳定性，是治疗肱骨近端复杂骨折，特别是粉碎骨折的理想方法。     

Die winkelstabile Plattenosteosynthese bei Frakturen am proximalen Humerus mit der LPHP (Locking Proximal Humerus Plate)

OBJECTIVE: Stable fixation of unstable proximal humerus fractures until bony consolidation. Early mobilization of the shoulder and early active rehabilitation program to ensure a good functional outcome and a good restoration of the activities of daily living. INDICATIONS: Unstable two-, three- and four-part fractures of the proximal humerus (classified according to the AO classification as: 11-A2, A3, B1, B2, B3, C1, C2, C3). Nonunions of the proximal humerus, especially at the neck. Pathologic fractures of the proximal humerus. CONTRAINDICATIONS: Comminuted humeral head fractures in old patients, which cannot be reconstructed adequately. Proximal humerus fractures in the immature patient. Local infection after previous surgery. SURGICAL TECHNIQUE: Deltopectoral approach. Blunt mobilization of the deltoid muscle. Suture loops through the supraspinatus tendon, the infraspinatus tendon, and the subscapularis tendon close to their bony insertion. Careful indirect reduction of the fracture fragments without further damage to their blood supply. Correct positioning of the LPHP (Locking Proximal Humerus Plate) on the lateral side of the humerus, approximately 5 mm below the tip of the greater tuberosity. Indirect approximation of the subcapital fracture component to the plate, by tightening a standard 3.5-mm cortical bone screw inserted into the first hole distal to the metaphyseal fracture line. Temporary fixation of the plate with 1.8-mm Kirschner wires. Fixed-angle fixation of the plate to the bone, using locking screws. Additional stabilization of the tuberosities to the plate with suture loops. RESULTS: Between January 1, 1997 and April 30, 2002, 64 patients with acute fractures of the proximal humerus were treated with fixed-angle plating at the UKH Graz. 36 patients meeting the inclusion criteria (that is primary operative stabilization within 14 days after trauma in a standardized way and minimal follow-up period of 12 months) were assessed 31 months after surgery on average, using the Constant Score and the DASH Score. The mean age of the 22 women and 14 men was 57.5 years (21-78 years). According to the AO classification eight fractures were classified as 11-A3, one fracture as B1, five fractures as B2, three fractures as B3, one fracture as C1, 16 fractures as C2, and two fractures as C3. A mean Constant Score of 62.6 points and an age-related Constant Score of 80.7% on average, as well as a DASH Score of 18.0 points were obtained, constituting a satisfactory result in three quarters of all patients. Complications observed were two humeral head necroses, one partial necrosis after a head-splitting fracture with nevertheless good clinical result, and a deep infection in two cases. Breakage of the plate was seen in one patient with an A3.3 fracture without medial buttress; no further surgery was necessary; the fracture healed after a short period of immobilization.     

锁定加压钢板治疗老年肱骨近端骨折

目的探讨肱骨近端锁定加压钢板治疗老年肱骨近端骨折的临床疗效。方法自2007年10月至2009年2月,采用肱骨近端锁定加压钢板治疗28例老年肱骨近端骨折患者,其中男性10例,女性18例;年龄60-82岁,平均68.6岁。根据N eer分型,二部分骨折7例,三部分骨折16例,四部分骨折5例。结果 28例均获得随访,随访时间8-14个月,平均11.2个月。所有骨折均愈合,骨折平均愈合时间3.4个月。根据Constan t评分,优18例,良7例,可3例,优良率89.3%。结论锁定加压钢板治疗老年肱骨近端骨折具有操作简单、固定可靠、并发症少等优点。必要时植骨,可提高骨折愈合率,特别适用于骨质疏松的肱骨近端粉碎性骨折。     

Operative Treatment of Severe Proximal Humeral Fractures

Results after the operative treatment of 41 severe proximal fractures of the humerus are reported. the fractures were classified according to Neer (1970a). the aim of treatment was accurate reduction and stable fixation of the fracture with screws or with screws and a plate.

When scored according to Neer's (1970a) functional assessment, results in the 31 patients re-examined more than 1 year postoperatively were excellent or satisfactory in 23 patients. Results were excellent or satisfactory in 14/15 patients with type III fractures, in 7/11 with IV, and 2/4 with type VI. in the only re-examined patient with a type V fracture the result was unsatisfactory.

The most common technical error was a too high positioning of the AO plate and persistent varus deformation of the head of the humerus. High positioning of the plate caused post-operative restriction in the movements of the glenohumeral joint because the implant impinged under the acromion during abduction. No aseptic necrosis of the humeral head was observed.

Of the patients of working age all but one returned to their preoperative occupations within a mean of 3.5 months after surgery.     

The cannulated blade plate 90 degrees for displaced proximal humeral fractures in elderly patients

Aim of the study was to analyse the results following osteosynthesis of proximal humerus fractures with cannulated blade plate 90 degrees (Synthes, Mathys Medizinaltechnik AG, Bettlach, Schweiz) in elderly patients. Between 6/1998 and 12/1999 we treated 20 patients (12 female, 8 male) > 65 years (65-92 y, 75 y) with the cannulated blade plate (fracture type according to AO: 8 x 11-A3, 5 x 11-B1, 3 x 11-B2, 1 x 11-B3 und 3 x 11-C2). Regarding to mechanical and functional advantages we modified the 90 degrees angulation of the implant by bending intraoperatively up to 110-120 degrees. Early post-op physiotherapy was permitted. The radiological results of all patients were evaluated and in 13 patients a clinical follow-up (median 8 months) was obtained. According to the Constant-score 62 points on average were achieved, which corresponds to a satisfactory result (contralateral shoulder 92 points). Complications due to the implant were loosening of the blade plate in 3 cases (A3, B2, C2) and 1 perforation of the blade plate (C2). The consecutive reoperation consisted in a compound osteosynthesis with the blade plate (A3, B2) in 2 cases, a prosthetic replacement and a removal of the implant (C2) in 1 case respectively. Neither infection, major nerve and vessel trauma nor avascular necrosis occurred. The cannulated blade plate 90 degrees represents a justified alternative in the treatment of displaced fractures of the proximal humerus in elderly patients. Commendable indications are fracture types A and B according to AO with stable fixation of the blade plate in the humeral head, which allow early physiotherapy and avoid an alteration of the rotator cuff. C-type fractures tend to complications (2/3).     

肱骨近端锁定钢板治疗老年肱骨外科颈粉碎骨折

目的评价肱骨近端锁定钢板治疗老年肱骨外科颈粉碎骨折的疗效。方法采用肱骨近端锁定钢板治疗31例老年肱骨外科颈粉碎骨折。平均随访6个月（4-14个月）。结果术后无伤口感染、骨折不愈合和内固定松动发生。骨折愈合时间为术后2．5～6．1个月。肩关节功能按照Constant评分标准，功能优9例，良18例，中4例，优良率87．1％。结论肱骨近端锁定钢板对老年胧骨外科颈骨折固定可靠、并发症少，可早期功能锻炼，具有防止复位丢失、保护板下血运和骨折愈合快等优点。     

Semitubular blade plate for fixation in the proximal humerus

Rigid internal fixation is frequently difficult to obtain in the proximal humerus, as osteoporotic bone and small fracture fragments may preclude firm purchase of plates and/or screws. We describe our clinical results using a semitubular plate, fashioned into a blade plate device, for fixation of four displaced fractures and three osteotomies of the proximal humerus. All patients were clinically and radiographically united by 4 months postoperatively and had a functional range of motion. The strength of this fixation was compared to that of an AO "T" plate in an oblique subcapital osteotomy model using 10 matched pairs of human humeri. No statistically significant difference could be demonstrated between the two fixation methods with regard to load to failure, yield load, energy absorbed to failure, or stiffness. As a consequence of these studies, we believe the semitubular blade plate expands the options available for challenging fixations in the proximal humerus.