肱骨近端锁定接骨板治疗肱骨近端复杂性骨折的回顾性分析

目的探讨肱骨近端锁定接骨板（locking proximal humeral plate，LPHP）治疗肱骨近端复杂性骨折的临床疗效。方法对2005年1月至2008年10月在我院行LPHP治疗并获得随访的31例复杂性患者进行回顾性分析，从患者年龄、受伤机制、骨折类型、手术时机、骨折复位质量、术后康复方法、内固定取出时间对肩关节功能影响进行评估。结果31例患者获得10-56个月的随访，平均26．5个月。按Neer分型标准：三部分骨折13例，四部分骨折18例。肩关节功能按照constant评分，平均81．3分，其中优13例，良12例，可3例，差3例，优良率80．6％。按照Logistic回归分析，不同骨折类型、手术时机、复位质量及术后康复方法对肩关节功能产生不同影响，差异有统计学意义（P〈0．05），而患者不同年龄、受伤机制和内固定取出时间对肩关节功能影响差异无统计学意义（P〉0．05）。结论LPHP治疗肱骨近端复杂骨折具有良好的疗效。在保护骨折端血运的前提下尽可能地解剖复位、妥善固定，合理处理大、小结节是获得良好手术疗效的关键。术后早期、积极、正确的康复锻炼是获得良好手术疗效的重要条件。

Treatment of complex proximal humeral fractures with locking proximal humeral plate

Objective To evaluate the effect of locking proximal humeral plate（LPHP） for complex proximal humeral fractures. Methods Thirty-one patients with the complex proximal humeral fractures were treated with locking proximal humeral plate and were followed up from January 2005 to October 2008. The clinical data was collected in terms of ages, lesion mechanism, type of fracture, surgery occasion, the quality of reduction, rehabilitation approach, the time to remove internal fLxation and shoulder joint function. Results All of the 31 cases were followed up for 10 to 56 months, with an average of 26.5 months. According to Neer classification, 13 patients were three-part fracture, 18 cases were four-part fracture. According to Constant scoring for shoulder joint function, the average scoring 81.3. The result was excellent in 13 cases, good in 12, fair in 3, and bad in 3, with the excellent-to-good rate of 80.6%. By Logistic regression analysis, the following variables in Constant scores were of statistic significance （P〈0.05）, including fracture type, surgery occasion, the quality of reduction, rehabilitation approach. But the following variables in Constant scores were no statistical significance （P〉0.05）, including patients ages, lesion mechanism, and the time to remove internal fixation. Conclusions The therapy for complex fracture of proximal humarus with LPHP could be approved to achieve a good clinical result. Under the ,premise of fracture blood supply protection, the key to good result includes making anatomic reduction as much as possible, undertaking excellent internal fixation and dealing with greater tubercle and lesser tubercle reasonably. It is important to initiate early, active and correct rehabilitation exercises postoperatively to improve the clinical efficacy.