锁定钢板治疗肱骨近端粉碎性骨折

目的 了解锁定钢板治疗粉碎性肱骨近端骨折的疗效及相关手术技术.方法 2003年2月-2007年3月,采用锁定钢板治疗肱骨近端粉碎性骨折34例,其中21例采用肱骨近端锁定钢板(locking proximal humerus plate,LPHP),13例采用肱骨近端锁定系统(proximal humerus interlockingsystem,PHILOS).根据Neer分型,三部分骨折30例,四部分骨折4例.结果 术后32例获得12～36个月随访,平均18.6个月.2例失访.术后骨折均愈合,无内固定失效,骨折平均愈合时间为10周.根据Constant评分标准评定:优4例,良23例,可4例,差1例;优良率为84.4%.其中60岁以下Constant评分平均为83(77～90),60岁以上平均为72(30～86).三部分骨折评分平均为76(70～90),而四部分骨折平均为60(30～74).结论 锁定钢板是治疗肱骨近端粉碎性骨折的有效方法.肱骨近端内侧的有效支撑以及减少软组织剥离是手术成功的关键.

Treatment of comminuted proximal humeral fractures by locking plate

Objective To investigate the surgical techniques and evaluate the results of locking plate in treatment of comminuted proximal humeral fractures. Methods From February 2003 to March 2007, 34 cases of Comminuted proximal humeral fractures were treated using locking plate manufactured by Synthes (21 cases with locking proximal humerus plate, LPHP; 13 cases with proximal humerus interlocking system, PHILOS). There were 9 males and 25 females. The ages of this group ranged from 43 to 81 years, with an average of 64.7 years. According to Neer classification, there were 30 cases of three-part fractures, and 4 cases of four-part fractures. Results The follow-up period of 32 cases ranged from 12 months to 36 months, the average being 18.6 months. Two were lost for follow up. Bone union was achieved in all the cases, with the mean healing period of 10 weeks. According to Constant scoring, the excellent and good result rate was 84.4%. Conclusion Locking plate is an effective method for treating comminuted proximal humeral fractures. Mechanical support of the medial region to maintain the reduction and minimal soft tissue striping of the fracture site ate important for the success of the surgery.