长型肱骨近端锁定钢板治疗肱骨近端并肱骨干骨折★

摘要

BACKGROUND:The domestic and international literatures have confirmed that the internal fixation of long proximal humeral locking compression plate has satisfactory effect on the treatment of proximal humerus fractures. OBJECTIVE:To investigate the clinical effect of internal fixation of long proximal humeral locking compression plate on the treatment of proximal humerus and humeral shaft fractures. METHODS:Sixteen cases with the proximal humerus and humeral shaft fractures were treated with long proximal humeral locking compression plate internal fixation, including seven males and nine females, aged 45-83 years old (average 71 years old). According to the Neer classification of proximal humerus, five cases had two parts of fracture, eight cases had three parts of fracture, and three cases had four parts of fracture;and according the AO classification of humeral shaft, five cases were classified as A1, six cases as B1, two cases as B2, two cases as C1 and one case as C3. Postoperatively, Constant-Murley scoring system was employed to evaluate the function of shoulder joint, and then the percentage was calculated for the corresponding evaluation. Modified Hospital for Special Surgery scoring system was adopted to evaluate the function of elbow joint. RESULTS AND CONCLUSION:Al cases were fol owed-up for 12-24 months (average 14.9 months), and al the cases had bone union in 8-17 weeks (average 12.1 weeks) after operation. Postoperatively, two cases suffered from fat liquoring, but healed after dressing. One case had the symptoms of radial nerve paralysis, one case had subacromial impingement syndrome and improved after treatment. No complications such as screw loosening, screw cut out or humeral head ischemic necrosis were observed. After treated for 12 months, the Constant-Murley score on fracture side was 76.87 in average (ranged 65-90), which was 83.41%in average (ranged 71.4%-93.8%) to the normal side, the clinical outcomes on shoulder were excel ent or good in 15 cases, satisfied in one case. By Hospital for Special Surgery scoring system, 13 cases were graded as excel ent, three cases as good, and the excel ent and good rate was 100%. Long proximal humeral locking compression plate for the treatment of the proximal humerus and humeral shaft fractures provides solid fixation and high satisfactory rate with minor complications.%　　背景：国内外均有文献报道证实长型肱骨近端内固定锁定钢板用于治疗肱骨近端骨折疗效显著。　　目的：总结应用长型肱骨近端内固定锁定钢板手术治疗肱骨近端合并肱骨干骨折的临床疗效。　　方法：纳入应用长型肱骨近端内固定锁定钢板治疗肱骨近端合并肱骨干骨折患者16例。其中男7例，女9例，年龄45-83岁，平均71岁。肱骨近端Neer分型，2部分骨折5例，3部分骨折8例，4部分骨折3例；肱骨干骨折AO分型A1型5例，B1型6例，B2型2例，C1型2例，C3型1例。内固定后肩关节功能采用Constant-Murley肩关节评分标准对患者两侧肩关节进行评分，同时计算评分百分比并作相应评价。肘关节采用改良HSS评分标准评估。　　结果与结论：16例患者均获随访，随访时间12-24个月，平均14.9个月。所有患者骨折均愈合，时间8-17周，平均12.1周。2例患者出现伤口脂肪液化，换药后均愈合。1例患者治疗后出现桡神经麻痹症状，1例患者出现肩峰撞击综合征，治疗后好转。无内固定松动、螺钉切割及肱骨头缺血坏死等并发症发生。治疗后12个月按 Constant-Murley 评分标准为65-90分，平均76.87分。与健侧百分比为71.4%-93.8%，平均83.41%。优良15例，满意1例。改良HSS肘关节评分优13例，良3例，优良率100%。说明长型PHILOS钢板治疗肱骨近端合并肱骨干骨折固定可靠，并发症少，疗效满意。