肱骨近端内固定锁定系统接骨板治疗老年性肱骨近端骨折

目的探讨锁定接骨板在治疗老年肱骨近端骨折的临床作用。方法2008年6月至2011年6月，应用AO PHILOS接骨板治疗老年肱骨近端骨折32例。经三角肌胸大肌肌间沟入路，术中C臂透视下复位骨折端，接骨板置于结节间沟外侧0．5cm、大结节顶点下方0．8～1．0cm。术后医生指导下早期康复锻炼。结果32例患者中28例术后获得随访，随访时间6—12个月，平均7．2个月。术后无腋神经血管损伤，无感染和伤口开裂。x线片显示骨折复位满意，钢板螺钉位置良好，无内固定松动断裂，无复位丢失，无骨折不愈合及肱骨头坏死病例。7例患者出现短时假性肩关节脱位，功能锻炼后自动复位；骨折端轻度复位不佳3例。骨折愈合时间13—32周，平均16．5周。所有患者均遗留有不同程度的肩关节活动受限，主要是上举受限。NEER评分：优9例，良11例，可8例，优良率71．4％。结论肱骨近端锁定接骨板是治疗老年人肱骨近端骨折的理想内固定材料具有固定可靠、对肱骨头血供影响小、并发症少等优点，利于术后早期功能锻炼。

Internal fixation of proximal humeral fractures with the proximal humeral internal locking system plate in the elderly

Objective To investigate the clinical effects of internal fixation of proximal humeral fractures with the proximal humeral internal locking system （PHILOS） plate in the elderly. Methods 32 elderly patients with proximal humeral fractures were treated with the PHILOS plate from June 2008 to June 2011. With C-arm X-rays during surgery, reduction and fixation were performed through pectoro-deltoid approach. The plate was placed 0.Scm to the lateral edge of the intertubercular groove and 0.8-1.0cm under the top of the greater tubercle. Early functional exercises were done under the doctor＇s direction. Results Among them, 28 patients were followed up postoperatively for an average period of 7.2 months （range; 6-12 months）. No neurovascular injury of the axilla, infection or wound dehiscence occurred after surgery. The postoperative radiographs showed satisfactory fracture reduction and good position of the plate and screws, without looseness or breakeness of internal fixation, loss of reduction, bone nonunion, and humeral head osteonecrosis. Short-term pseudo-dislocation of the shoulder happened to 7 patients, who got recovered after functional exercises. 3 patients had slightly bad reduction of fracture. The mean fracture healing time was 16.5 weeks （range; 13-32 weeks）. Limited range of motion of the shoulder occurred to all patients in different degrees, and mainly the uplift was limited. According to the Neer shoulder score, 9 cases were excellent, 11 cases were good and 8 cases were fair, and the excellent and good rate was 71.4%. Conclusions The PHILOS plate is an ideal material of internal fixation for the elderly patients with proximal humeral fractures, which can firmly fix the fractures and possesses such advantages as less disturbance of the blood supply of the humeral head, less complications and so on. It is also beneficial for early functional exercises after the surgery.