锁定加压钢板治疗肱骨近端骨折

2005年3月～2008年3月,我科应用锁定加压钢板内固定治疗肱骨近端骨折25例,疗效满意。1材料与方法1.1病例资料本组25例,男20例,女5例,年龄17～68岁。左侧13例,右侧12例。按Neer分型：二部分骨折16     

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(LPHP)治疗肱骨近端骨折的临床疗效。方法 采PHP治疗29例肱骨近端骨折，按Neer分类法，二部分骨折11例；三部分骨折12例；四部分骨折6例。结果 平均愈合时间7．4周(6～12周)：按照Constant评分标准，功能优18例，良为8例，中为3例，优良率为89．6％。结论 肱骨近端锁定接骨板治疗眩骨近端骨折手术简单、固定可靠、并发症少、骨折愈合率高特别是老年骨质疏松患者首选治疗方法。     

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(LPHP)治疗肱骨近端骨折的临床疗效.方法 采用LPHP治疗47例肱骨近端骨折.术后均加强功能锻炼.患肩功能按Constant肩关节评分系统进行评价.结果 患者均获随访,时间6～18(12±6)个月.骨折均愈合,时间4～8(6±2)个月.根据Constant评分标准评分为78～96(87.2±8.5)分,功能优29例,良11例,中7例,优良率为85.1%.结论 LPHP治疗肱骨近端骨折具有坚强固定、合并症少、手术简单、骨折愈合快,功能恢复好等优点,特别适合用于治疗老年骨质疏松患者.     

锁定钢板治疗肱骨近端骨折

2009年1月～2011年5月,我科采用肱骨近端锁定加压钢板治疗64例肱骨近端移位骨折患者,效果良好,报道如下。1材料与方法1.1病例资料本组64例,男38例,女26例,年龄18～75岁。左侧27例,     

锁定加压接骨板内固定治疗肱骨近端骨折

目的探讨肱骨近端锁定接骨板内固定治疗中老年肱骨近端粉碎性骨折的临床疗效。方法自2005年5—2007年1月，应用肱骨近端锁定接骨板内固定治疗肱骨近端粉碎性骨折12例，其中男4例，女8例；左侧5例，右侧7例；年龄60-75岁，平均66岁。根据Neer分类：二部分骨折7例，三部分骨折4例，四部分骨折1例，均为闭合性新鲜骨质疏松性骨折。采用三角肌、胸大肌间隙入路，9例行自体骨植骨术。结果12例均得到随访，随访时间4-18个月，平均10个月。所有骨折均愈合，平均愈合时间12周，根据Constant评分，优5例，良5例，中2例，优良率83．3％。结论肱骨近端锁定接骨板内固定治疗中老年肱骨近端粉碎性骨折具有固定可靠、退钉率低、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。     

锁定接骨板治疗肱骨近端复杂骨折

目的探讨肱骨近端锁定接骨板（LPHP）治疗肱骨近端复杂骨折的临床疗效。方法回顾分析本院2003年1月至2005年10月采取LPHP治疗31例肱骨近端复杂骨折。按Neer分型，3部分骨折22例；4部分骨折9例。结果31例经5～13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LPHP治疗肱骨近端复杂骨折固定可靠、骨折愈合率高、可行早期功能锻炼，功能恢复好。     

肱骨近端锁定接骨板治疗肱骨近端粉碎性骨折

目的 探讨应用肱骨近端锁定接骨板(locking proximal humerus plate,LPHP)内固定治疗肱骨近端粉碎性骨折的可行性和疗效.方法 对2004年9月至2007年9月收治并获得随访的18例肱骨近端骨折进行回顾性分析,其中男7例,女11例,年龄25～79岁,平均52.8岁.所有骨折均按Neer分型:二部分骨折4例,三部分骨折6例,四部分骨折8例,其中骨质疏松7例.手术经三角肌、胸大肌间隙入路,采用肱骨近端锁定接骨板对骨折进行固定,对其中6例存在严重骨缺损患者进行自体骨植骨.结果 随访8～24个月,平均12.5个月,骨折均愈合.采用Neer肩关节功能评分标准评定:优6例,良7例,中3例,差2例,优良率为72.2%.合并内翻畸形1例,肱骨头缺血性坏死2例(术后1年行人工肱骨头置换术),肩关节创伤性关节炎2例,骨折延迟愈合1例.结论 肱骨近端锁定接骨板内固定是一种有效的适宜于肱骨近端粉碎性骨折的治疗方法 ,既能实现对骨折断端的稳固固定作用,又避免了对骨块附着软组织和骨膜的过多剥离,可有效地遏制肱骨头的缺血性坏死.     

锁定钢板治疗老年肱骨近端骨折

<正>2005年3月~2010年12月,我院应用锁定钢板治疗36例老年肱骨近端骨折患者,取得了良好疗效,报道如下。1材料与方法1.1病例资料本组36例,男16例,女20例,年龄60~85岁。左侧20例,右侧16例。闭合骨折33例,开放骨折3例。按Neer分型:二部分骨折8例,三部分骨折24例,四部分骨折4例。均为新鲜骨折。合并心、脑、肝、肾等脏器疾     

Locking plate osteosynthesis for fractures of the proximal humerus

BACKGROUND: Beside non-operative treatment the therapeutic options for proximal fractures of the humerus range from closed reduction and transcutaneous K-wiring to total joint replacement. While the first is regarded as minimally invasive the latter is a rather complex intervention. Plating has been disregarded as combining the disadvantages of an extended approach with too often insufficient primary postoperative stability. The new concept of completely angle stabile plate fixation aims on improving this balance by achieving greater stability even in osteoporotic fractures. STUDY DESIGN: This retrospective analysis compares 51 patients treated with a partially (39) or complete (12) angle stabile humeral plate (K?nigseeplatte in two modifications) with 32 patients treated according to surgeons preference with conventional plates or K-wires. Both groups were treated at the same department during the same period and did not differ in their age nor sex distribution. RESULTS: Until discharge there were 2 secondary dislocations discovered in group 1 and 7 in group 2. The follow-up rate was 47.1 % (24/51) in group 1 and 46.8 % (15/32) in group 2. The time interval from surgery amounted to 1.2 (0.66-1.75) and 1.0 (0.72-1.32) years respectively. Among the patients available for follow-up in group 1 8 had sustained a two-, 8 a three- and 3 a four-part fracture according to Neer's classification. In group two there were accordingly 2 two-, 8 three- and 1 four part fractures. Clinical assessment using Neer's score revealed an average of 71,8 (63.9-79.8) points in group 1 and 67.6 (47.3-78.7) in group 2. When the results of Neer's scores were expressed in percentage of the unaffected arm a mean of 73.6 (65.6-81.8) in group 1 and 69.3 (51.8-86.9) was obtained. The only statistically significant difference was observed within the sub-group of three-part fractures: treated by angle stabile plates (group 1) these patients (n = 8) achieved a mean Neer-Score of 81 (77-86) compared to 68 (52-84) (n = 8). In group 1 70.8 % of patients followed-up presented an "excellent" or "good" result according to Neer's criteria, in group 2 60 % did so. CONCLUSION: We conclude from our first experience with angle stabile plates for fractures of the proximal humerus that particularly in three part fractures this method might improve functional outcome and is worth further consideration and testing.     

肱骨近端锁定钢板治疗儿童股骨转子部骨折

正2009年1月~2013年12月,我科采用肱骨近端锁定钢板内固定治疗10例股骨转子部骨折患儿,疗效满意,报道如下。1材料与方法1.1病例资料本组10例,男7例,女3例,年龄6~12岁,均为闭合骨折。其中转子间骨折4例,根据Evans分型:Ⅰ型2例,Ⅱ型2例;转子下骨折6例,根据Seinsheimer分型:Ⅰ型2例,Ⅱ型3例,Ⅲ型1例。受伤至手术时间2 h~3d。1.2治疗方法全身麻醉下手术。取     

肱骨近端锁定接骨板治疗肱骨近端外展嵌插四部分骨折的疗效分析

目的 探讨肱骨近端锁定接骨板治疗肱骨近端外展嵌插四部分骨折的疗效.方法2005年11月至2006年12月经j角肌胸大肌入路采用AO肱骨近端锁定接骨板治疗18例肱骨近端外展嵌插四部分骨折患者,男8例,女10例;平均年龄66.4岁(57～74岁).骨折Neer分型:均为肱骨近端外展嵌插四部分骨折.受伤至手术时间平均为6.3 d(5～11 d).记录术中手术时间和出血量.末次随访时采用Constant-Murley肩关节评分标准评定患者肩关节功能.结果本组患者手术时间为70～125min,平均95 min;术中出血量为200～400 mL,平均350 mL.18例患者术后获35～45个月(平均40.6个月)随访.骨折均获愈合,临床愈合时间平均为12周(10～14周).2例患者发生Ⅱ～Ⅲ期肱骨头缺血性坏死,1例发生Ⅳ期肱骨头缺血性坏死.末次随访时Constant-Murley肩关节评分平均为84.2分(67～94分);其中优9例,良6例,一般3例,优良率为83.3%.肩关节活动度:前屈上举平均为164.0°±29.0°,体侧外旋平均为40.5°±21.3°,内旋达T7～T8(L2～T5).结论 肱骨近端锁定接骨板固定是治疗肱骨近端外展嵌插四部分骨折较理想的方法,其固定确切,保护了肱骨头及骨折端的血供.     

肱骨近端锁定接骨板治疗肱骨近端外展嵌插四部分骨折的疗效分析

目的 探讨肱骨近端锁定接骨板治疗肱骨近端外展嵌插四部分骨折的疗效.方法2005年11月至2006年12月经j角肌胸大肌入路采用AO肱骨近端锁定接骨板治疗18例肱骨近端外展嵌插四部分骨折患者,男8例,女10例;平均年龄66.4岁(57～74岁).骨折Neer分型:均为肱骨近端外展嵌插四部分骨折.受伤至手术时间平均为6.3 d(5～11 d).记录术中手术时间和出血量.末次随访时采用Constant-Murley肩关节评分标准评定患者肩关节功能.结果本组患者手术时间为70～125min,平均95 min;术中出血量为200～400 mL,平均350 mL.18例患者术后获35～45个月(平均40.6个月)随访.骨折均获愈合,临床愈合时间平均为12周(10～14周).2例患者发生Ⅱ～Ⅲ期肱骨头缺血性坏死,1例发生Ⅳ期肱骨头缺血性坏死.末次随访时Constant-Murley肩关节评分平均为84.2分(67～94分);其中优9例,良6例,一般3例,优良率为83.3%.肩关节活动度:前屈上举平均为164.0°±29.0°,体侧外旋平均为40.5°±21.3°,内旋达T7～T8(L2～T5).结论 肱骨近端锁定接骨板固定是治疗肱骨近端外展嵌插四部分骨折较理想的方法,其固定确切,保护了肱骨头及骨折端的血供.     

锁定钢板与半肩关节置换治疗肱骨近端骨折临床疗效系统评价

目的通过文献系统综述,比较切开复位锁定钢板内固定与半肩关节置换治疗严重肱骨近端骨折后临床疗效及常见并发症方面的差异,以评价两种治疗方法的优劣。方法计算机检索Pubmed、Embase、Cochrane数据库2010年10月31以前有关锁定钢板及半肩关节置换治疗肱骨近端骨折的前瞻性或回顾性临床研究文献。阅读评价文献质量并提取有效数据,采用SPSS17.0软件进行描述性统计分析。结果37篇文献纳入系统评价,共2089例患者。平均Constant-Murley功能评分,锁定钢板组为72.37(SD=6.68),半肩关节置换组为52.43(SD=7.64),但锁定钢板组平均Constant-Murley评分高于半肩关节置换组之差异,可能与选择偏倚和评估偏倚相关。锁定钢板组总并发症发生率变异较大,最低为6.2%,最高达61.7%。锁定钢板组常见并发症有螺钉穿出(7.5%,n=87)、肩峰撞击(2.8%,n=33)、肱骨头缺血坏死(7%,n=81)、骨折不愈合(1.2%,n=14)及内固定失效(4.6%,n=53),其中14%需要二次手术处理。半肩关节置换术后常见并发症有假体松动及错位(5.1%,n=48)、大结节异常(25.3%,n=235)、严重疼痛(2.8%,n=26)。结论目前缺乏有说服力的临床证据证明锁定钢板与半肩关节置换治疗严重肱骨近端骨折的优劣差异,应针对不同患者的具体情况采取个体化治疗策略。仍需要更多大样本、多中心、高质量的临床随机对照研究进一步验证。     

锁定钢板治疗老年肱骨近端粉碎性骨折

目的 探讨应用锁定钢板治疗老年骨质疏松性肱骨近端粉碎性骨折的临床效果。方法 对我科在2007年1月~2009年1月应用肱骨近端加压锁定钢板(Locking proximal humeral plate, LPHP)治疗26例肱骨近端粉碎性骨折进行回顾性分析。按Neer分型,3部分骨折19例,4部分骨折7例,均为新鲜骨折。结果 术后随访24例,随访时间9~24个月,骨折全部愈合,无肱骨头缺血性坏死。以Neer评分评估其功能,优良率达83.33%。结论 锁定加压钢板治疗老年肱骨近端粉碎性骨折稳定牢固,疗效满意。     

Locking plates in proximal humerus fractures

It is well known that proximal humerus fractures are among the three most frequent fracture types. Epidemiological invetsigations show that in people elder than 60 years the fracture of the proximal humerus is more frequent than fractures of the hip region (17). Over the last decades several techniques have been applied for treatment of proximal humerus fractures. Widely accepted is the initiation of a conservative treatment regimen for undisplaced fractures, however, the standard treatment for displaced fractures, especially three and four part fractures, is still the center of scientific debate. Many different implants have been tested and investigated, thus demonstrating lack of sufficient results. Over the last years the development of angle stable, locking implants started and clinical studies demonstrated encouraging results. In our clinic the locking proximal humerus plate and the PHILOS plate advanced to the implant of choice for treatment of displaced proximal humerus fractures. There are still cases of implant failure and humerus head necrosis, but most of these complications were caused by the fracture type and not an implant specific problem. However the overall results with these new implants are encouraging. Key words: locking plates, proximal humerus fracture, humerus, humerus fracture, PHILOS, PHP.     

锁定钢板治疗胫骨远端骨折

胫骨远端骨折因软组织覆盖少,手术后并发症较多,治疗存在一定的困难。2007年1月-2008年12月,我科应用锁定钢板治疗胫骨远端骨折12例,取得满意疗效。     

Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus

Background and purpose

There is considerable uncertainty about the optimal treatment of displaced 4-part fractures of the proximal humerus. Within the last decade, locking plate technology has been considered a breakthrough in the treatment of these complex injuries.

Methods

We systematically identified and reviewed clinical studies on the benefits and harms after osteosynthesis with locking plates in displaced 4-part fractures.

Results

We included 14 studies with 374 four-part fractures. There were 10 case series, 3 retrospective observational comparative studies, 1 prospective observational comparative study, and no randomized trials. Small studies with a high risk of bias precluded reliable estimates of functional outcome. High rates of complications (16–64%) and reoperations (11–27%) were reported.

Interpretation

The empirical foundation for the value of locking plates in displaced 4-part fractures of the proximal humerus is weak. We emphasize the need for well-conducted randomized trials and observational studies.There is considerable uncertainty about the optimal treatment of displaced 4-part fractures of the proximal humerus (Misra et al. 2001, Handoll et al. 2003, Bhandari et al. 2004, Lanting et al. 2008). Only 2 small inconclusive randomized trials have been published (Stableforth 1984, Hoellen et al. 1997). A large number of interventions are used routinely, ranging from a non-operative approach to open reduction and internal fixation (ORIF), and primary hemiarthroplasty (HA).In the last decade, locking plate technology has been developed and has been heralded as a breakthrough in the treatment of fractures in osteoporotic bone (Gautier and Sommer 2003, Sommer et al. 2003, Haidukewych 2004, Miranda 2007). Locking plate technique is based on the elimination of friction between the plate and cortex, and relies on stability between the subchondral bone and screws. Multiple multidirectional convergent and divergent locking screws enhance the angular stability of the osteosynthesis, possibly resulting in better postoperative function with reduced pain. Reported complications include screw cut-out, varus fracture collapse, tuberosity re-displacement, humeral head necrosis, plate impingement, and plate or screw breakage (Hall et al. 2006, Tolat et al. 2006, van Rooyen et al. 2006, Agudelo et al. 2007, Gardner et al. 2007, Khunda et al. 2007, Ring 2007, Smith et al. 2007, Voigt et al. 2007, Egol et al. 2008, Kirchhoff et al. 2008, Owsley and Gorczyca 2008, Brunner et al. 2009, Micic et al. 2009, Sudkamp et al. 2009). The balance between the benefit and harms of the intervention seems delicate.Several authors of narrative reviews and clinical series have strongly recommended fixation of displaced 4-part fractures of the humerus with locking plates (Bjorkenheim et al. 2004, Hente et al. 2004, Hessler et al. 2006, Koukakis et al. 2006, Kilic et al. 2008, Korkmaz et al. 2008, Shahid et al. 2008, Papadopoulos et al. 2009, Ricchetti et al. 2009) and producers of implants unsurprisingly strongly advocate them (aap Implantate 2010, Stryker 2010, Synthes 2010, Zimmer 2010). Despite the increasing use of locking plates (Illert et al. 2008, Ricchetti et al. 2009), we have been unable to identify systematic reviews on the benefits and harms of this new technology in displaced 4-part fractures. Thus, we systematically identified and reviewed clinical studies on the benefits and harms after osteosynthesis with locking plates in displaced 4-part fractures of the proximal humerus.     

Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus

Background Metal particles are generated during bone preparation in knee arthroplasty. These particles may produce third-body wear, or may have a role in osteolysis. Knowledge of their characteristics may help in the development of methods to reduce the amount of metal debris during bone cutting procedures.

Material and methodsWe performed bony resection of the distal femur and proximal tibia on 15 pig knees, simulating a total knee arthroplasty (TKA). Metal debris was collected from the saw blades, cutting blocks and bone surfaces and cleaned for microanalysis.

Results The average loss of metal from the saw blades was 1.13 mg. The average volume of a wear particle was 3.4 × 10^-16m³. From this, it was estimated that approximately 500,000 particles are released from the saw blade alone. Material analysis of the particles indicated that the majority originated from the metallic cutting guides, suggesting that many millions of wear particles would be generated during the surgical procedure. Two particle shapes predominated: platelet shape and ploughed shape.

Interpretation Wear particles are produced during resection for a TKA. These may enter the artificial articulation and cause accelerated wear and macrophage activation. Redesign of cutting blocks and saw blades may reduce the amount of debris produced during surgery.