闭合复位内置肱骨近端锁定钢板治疗肱骨近端骨折

目的探讨应用闭合复位内置肱骨近端锁定钢板(LPHP)内固定治疗肱骨近端骨折的方法及疗效。方法应用肱骨LPHP内固定治疗肱骨近端骨折22例。根据Neer分型,二部分骨折6例,三部分骨折7例,四部分骨折6例。合并骨质疏松老年患者9例。取坐位,自肩部前外侧、肩峰前2 cm处纵向切开皮肤约2.5 cm,沿肌纤维纵向分离三肌角膜,顺着骨膜潜行将钢板插入。X-ray透视下使骨折复位,近端用锁定螺钉固定,远端经皮引入螺钉。术后第3天肩关节开始主动及被动活动,根据骨折类型及术后稳定性加强术后功能锻炼。结果17例获随访,随访时间3~24个月,平均18个月,骨折均愈合。按Neer肩关节功能评分标准评定,优10例,良6例,满意1例,优良率94.11%。结论经肩部前外侧潜行置入锁定钢板,闭合复位内固定治疗肱骨近端骨折手术简便,创伤小,内固定紧张,有利于骨折愈合,利于早期功能活动,减少关节粘连,更利于功能恢复。

Closed reduction and internal locking plate in treatment of proximal humerus fractures

Objective To study the clinical effects and the methods of closed reduction and locking plate in treat proximal humerus fractures.Methods Twenty two cases of proximal humerus fractures were treated with locking proximal humerus plates,including 19 cases treated with closed reduction and internal fixation using locking proximal humerus plates.Of the 19 cases,there were 10 male and 9 female patients with ages ranging from 26 to 78 years(average,48.6 years).Six patients sustained two-part,7 three-and 6 four-part fracture according to Neer's classification.Nine cases combined with senile osteoporosis.Patients were kept in sitring position.A 2.5 centimetres incision was designed on the anterolateral shoulder,2 cm from anterior acromion.The deltoid muscle was separated along the muscle fibers.Plate was inserted beneath the periosteum.Closed reduction was performed under X-ray,locking screws in proximum and percutaneous pinning in the distal.There days after operation,initiative and passive function exercise was performed according to classification of fracture and postoperative stability.Results The follow-up of 17 cases lasted for 3 to 24 months(average,18 months).94.11% of patients followed up presented an "excellent" or "good" result according to Neer's classification.Conclusion Closed reduction and locking plate for treating proximal humerus fractures is simple,minimally invasive,rigid internal fixation and in favor of fracture healing,which benifits early functional exercise,joint adhesion improvement and function recovery.