肱骨近端锁定钢板治疗肱骨近端复杂性骨折

目的探讨可能影响锁定钢板置入治疗肱骨近端复杂骨折稳定性的相关因素。方法上海奉城医院自2004年1月至2007年4月,采用切开复位锁定钢板内固定法治疗35例肱骨近端复杂性骨折患者,根据Neer分类,Ⅲ型骨折25例,Ⅳ型骨折10例。经三角肌胸大肌间入路,钝性分开三角肌,复位时尽量减少对骨折血运的破坏,将锁定钢板置于肱骨的侧方,大结节下方0.5 cm处,克氏针临时固定,锁定螺钉固定钢板,将移位的大小结节固定于钢板上。术后患肢三角巾悬吊胸前位固定。术后随访12～26个月,平均18个月,定期复查X线片,观察材料及宿主反应。术后功能评价采用Neer评分。结果35例获得平均18个月（12～26个月）的随访;35例骨折全部愈合,愈合时间为4～10个月,平均4.6个月。按Neer评分标准评分,优23例,良9例,可3例,总优良率达91.4%。结论LPHP置入有高度的稳定性,治疗肱骨近端骨折,尤其是粉碎性及骨质疏松性骨折较理想。

Locking Proximal Humeral Plate T herapy for Complex Fracture of the Proximal Humarus

Objective To investigate the related factors of influencing the stability of locking steel plate in the treatment of the complex fractures of proximal humerus.Methods A total of 35 cases with proximal humeral fractures were treated with open reduction locking proximal humeral plate from January 2004 to April 2007 in Feng Cheng Hospital,including 25 cases with Ⅲ fracture and 10 cases with Ⅳ fracture.Reduction and fixation were done via deltopectoral groove approach to reduce the breakage of the blood circulation on the fracture while reduction.The steel plate was targeted beside the humerus,0.5 cm under the greater nodule,and was fixed by Kirschner needle,then the bolt was locked and the steel plate was fixed.At last the dislocated nodules were fixed at the s teel plate.After operation,the lesioned limb was hanged before the chest to fix with the triangular bandage.The follow-up period was 1226 months with average of 18 months.Periodical reexamination of X-ray slice was conducted to observe the reaction to the material and sufferers.Function was evaluated according to Neer scoring system.Results The average follow-up period of 35 cases was 18 months,and 35 cases were in union of fracture.The healing time was 410 months with average of 4.6 months.The result of Neer scores showed that 23 cases were excellent,9 cases were good,and 3 cases were fair.The rate of the good and excellent is 91.4 percent.Conclusion Due to the high stability,locking proximal humeral plate is effective for proximal humeral fracture,particularly for osteoporosis and comminuted fractures.