长PHILOS钢板结合MIPO技术治疗肱骨近端伴肱骨干骨折临床研究

目的总结应用长型肱骨近端内固定锁定钢板(PHILOS),经微创钢板内固定(MIPO)技术,即肩峰下前外侧经三角肌入路治疗肱骨近端伴肱骨干复杂骨折的临床疗效。方法 2007年3月至2009年12月,应用长型PHILOS结合MIPO技术治疗肱骨近端伴肱骨干复杂骨折18例。其中男11例,女7例;年龄28～69岁,平均58.5岁。均为新鲜闭合性骨折,受伤至手术时间5～10 d。肱骨近端骨折中Neer分型2部分骨折2例,3部分骨折12例,4部分骨折4例;肱骨干骨折中AO分型A1型3例,A2型1例,B1型5例,B2型2例,B3型3例,C1型2例,C3型2例。术后肩关节功能评价采用Neer评分,肘关节功能评价采用美国特种外科医院(HSS)评分。结果 18例患者均获随访,随访时间11～31个月,平均14.6个月。术后出现桡神经麻痹症状1例,12周内自行恢复;出现肩关节慢性轻度疼痛2例,予以对症治疗后逐渐缓解。术后12个月18例全部达骨性愈合,无退钉或内固定松动等并发症发生。按Neer评分,肩关节功能优7例,良9例,中2例,优良率为88.9%;按HSS评分,肘关节功能优16例,良2例,优良率为100%。结论长型PHILOS结合MIPO技术,具有血运破坏少、固定可靠、并发症少、满意率高等优点,是治疗肱骨近端伴肱骨干骨折的一种新方法。

Clinical research on treatment of proximal humerus with ipsilateral humeral shaft fractures with Iong-PHILOS through MIPO technique

Objective To report the outcomes of open reduction and internal fixation in proximal humerus fractures with ipsilateral humeral shaft fractures treated with long-proximal humerus internal locking system(PHILOS),through minimally invasive percutaneous osteosynthesis(MIPO) technique,a subacromial anterolateral deltoid-split approach.Methods From March 2007 to December 2009,18 long-PHILOS plates were implanted in 11 men and 7 women,with a mean age of 58.5 years(range,28-69 years).All fractures were acute and closed,and the interval from injury to operation was 5-10 days.According to the Neer classification,2,12,and 4 patients had displaced 2-,3-,or 4-part fractures respectively,while for the humeral shaft fracture,3 cases were classified as A1,1 as A2,5 as B1,2 as B2,3 as B3,2 as C1 and 2 as C3 according to AO/ASIF classification system.Functional outcome was assessed using the Neer scoring system for shoulder and the hospital for special surgery(HSS) score for elbow respectively.Results All patients were assessed clinically and radiographically after a mean follow-up of 14.6 months(range,11-31 months).One patient had transient symptom of radial nerve paralysis,which disappeared within 12 weeks,and two cases felt chronic mild pain in shoulder joint and gradually relieved after receiving symptomatic treatment.Radiological union was achieved within 12 months in all fractures.No complications such as internal fixator loosening or avascular necrosis of humeral head were seen.Seven cases were graded as excellent,9 as good,2 as fair,and the excellent and good rate was 88.9% according to Neer scoring system.By HSS score,16 cases were graded as excellent,2 as good,and the excellent and good rate was 100%.Conclusions Internal fixation with the long-PHILOS plate through MIPO technique should be a new reliable option in the operative treatment of proximal humerus with ipsilateral humeral shaft fractures.Because this method has the advantage of less blood damage,secure fracture fixation as a result that quick and uneventful fracture healing and very satisfactory clinical outcome was achieved.