肱骨近端锁定型钉板治疗老年人移位的肱骨近端骨折

目的 探讨肱骨近端锁定型钉(PHILOS)板治疗老年人移位的肱骨近端骨折的疗效。方法 回顾性分析2004年2月至2007年3月用PHILOS板治疗的36例肱骨近端骨折患者,Neer分型二部分骨折14例，三部分骨折17例，四部分骨折5例。统计手术时间、输血量和手术并发症，评价肩关节功能。 结果 患者平均年龄72.2岁，平均随访14.5个月。术中平均输血165.2 ml，术后X线显示骨折复位满意，无神经、血管损伤病例，心脑血管意外1例，肺炎1例，骨折愈合时间3～5个月，未发现肱骨头坏死,Neer评分：30例(83.3％)优良。分析显示骨折类型（Neer分型）、受伤至手术时间（术后3d内早期手术）与骨折愈合后肩关节功能恢复具有相关性，年龄、性别、美国麻醉医师协会(ASA)评分与Neer评分两组比较差异无统计学意义。 结论 PHILOS板是治疗老年人移位的肱骨近端骨折的有效方法，固定牢固稳定，可早期功能锻炼，适合于伴有骨质疏松的老年患者。

Fixation of displaced proximal humeral fractures with proximal humeral internal locking plate in the elderly

Objective To investigate the treatment effect of the proximal humeral internal locking system (PHIL()S) on the elderly patients with displaced proximal humeral fractures.Methods From Feb 2004 to Mar 2007, 36 patients (mean age: 72.2 years) with proximal humeral fractures were treated with PHILOS plate fixation which included 14 cases with 2-part, 17 cases with three-part and 5 cases with four-part fractures according to Neer classification. Operation time,intraoperative blood loss, blood transfusion, perioperative complications and function evaluation of the operated shoulder joint were calculated with 14.5 months follow-up at average.Results The average operation time and blood loss were (61.5± 11.6) min and ( 165.2±91.2) ml, respectively. 1 case with accidents of blood vessel and 1 case with pneumonia were found without neurovascular injuries. All fractures were radiographically healed in an average of 3-5 months. No necrosis of humeral head appeared and 30 (83.3％) cases were excellent or good according to Neer scoring system. Two part fracture and early operation ( within 3 days after operation) might improve the postoperative function of shoulder joint, but the patient's age, gender and ASA score were not statistically with Neer score.Conclusions PHILOS plate fixation is a suitable procedure for displaced proximal humeral fractures via stable fixation and early rehabilitation, especially for elderly patients combined with osteoporosis.