锁定钛板内固定治疗肱骨近端不稳定骨折

目的评价肱骨近端不稳定骨折切开复位锁定钛板内固定的效果，并描述我们的操作技术。方法自2007年5月至2010年5月治疗不稳定肱骨近端骨折38例，其中资料完整32例，男17例，女15例；平均年龄55．1岁（42～75岁）。左侧15例，右侧17例。依据Neer分型进行分类。手术采用三角肌胸大肌间隙入路。采用螺纹克氏针临时固定外科颈，对于大、小结节骨折采用不可吸收性缝合线牵引，复位后以锁定钛板固定外科颈，不可吸收性缝合线或钛缆以“8”字张力带固定大小结节骨折。结果通过2年以上随访，应用Constant—Murley评分表评价结果，2l例优，7例良好，3例中，1例较差。骨折全部愈合，23例解剖复位，3例患者肱骨头缺血性坏死。无内固定失效、感染等并发症。结论锁定钛板是治疗肱骨近端不稳定骨折的优良内固定系统，应用锁定钛板治疗此类骨折可获得良好的疗效。

Trentment of the Unstable Proximal Humeral Fractures with Locking Plates

Objective To evaluate the clinical outcomes of the proximal humeral plate in treatment of displaced unstable proximal humeral fractures. Methods 32 cases of unstable proximal humeral fractures in 38 were treated from May 2007 to May 2010. All patients were classified according to the Neer classification. Deltopectoral approach was used in all patients. Surgical neck fracture was fixed with Kirschner wire temporarily. Fracture fragments of Greater tuberosity and small nodules were tracted with non-absorbable suture. After reduction,the proximal humeral plates were used to fixe surgical neck of humeral,non-absorbable sutures or titanium cable were used to fix the nod ules fracture. Results By 2 years of follow-up ,there were excellent in 21 cases,good in 7 cases ,mean in 3 cases ,and poor in 1 case according to Constant-Murley score. All fractures healed, 23 patients obtained anatomic reduction, 3 pa- tients followed with ischemic necrosis of the humeral head. There was no fixation failure ,infection and other complica- tions. Conclusion Proximal humeral locking plate is an excellent fixation for treatment of the unstable proximal humeral fractures. We achieved good results applying locking plate to treat such fractures.