Objective To evaluate the surgical treatment and clinic outcome ofpercutanous fixation with precontoured long PHILOS plate on metadiaphyseal fractures of the proximal humerus. Methods 13 patients of acute metadiaphyseal fractures of the proximal humerus were surgical treated by percutanous fixation with precontoured PHILOS plate from Febmary 2009 to February 2010. There were 4 males and 9 females with an average age of 72.9 years (range, 54～87 years). All the fractures on humeral shaft were classified by AO/OTA as type-B (n=6),type-C (n=7) and all the fractures extended to proximal humerus, which could be classified by Neet as type-I (n=9), type-ll (n=2)and type-III (n=2). The deltopectoral approach or lateral deltoid-splitting approach were used in proximal incision, and the operation time and blood loss were recorded in every case, including all the complications postoperatively. Functional assessment was done by Constant-MurIcy score and percentage to oormal side on shoulder, and MEPI score on elbow. Results The dcltopectoral approach was used in 8 patients while the lateral deltoid-splitting approach was used in 5 patients, the operation time was 96.5 minutes in average (range, 60～180 minutes), the blood loss was 238.5ml in average (range, 100～400mi). All the patients were followed-up in 16.9 months in average (range, 11 ～23 months), the fracture was healed in 11.6 weeks in average (range, 7～17 weeks). There was no iatrogenic radial nerve injuried postoperatively, instead of cutaneous antebrachii lateralis nerve injuried in 1 case and scapulohumeral pcriarthritis in another case temporarily. At the final follow-up, the Constant-Murley shoulder score on fracture side was 79 in average (range, 65～91), which was 87.6％in average (range, 75.8％～95.6％) to normal side, the clinical outcomes rnon shoulder were excellent or good in 12 cases (92.3％), satisfied in 1 cases.The MEPI was 96.9 in average (range,rn90～100). Conclusions Percutanous fixation with precontoured long PHILOS plate might decrease the further injury on rnhumeral soft tissue, and prevent the iatrogenic radial nerve injury distally. With satisfied clinic outcomes, it is suggested rnto be used at surgical treatment on metadiaphyseal fractures of the proximal humerus.%目的 评价扭转塑形的长型PHILOS接骨板经皮内固定治疗肱骨中上段折的初步疗效.方法 2009年2月至2010年2月,应用扭转塑形的长型PHILOS接骨板经皮内固定治疗肱骨中上段骨折13例,其中男4例,女9例,年龄54～87岁,平均72.9岁.按AO/OTA分型,B型6例,C型7例,骨折线均不同程度累及肱骨近端,按Neer 分型:Ⅰ型9例,Ⅱ型2例,Ⅲ型2例,分别采用胸三角肌入路和外侧三角肌入路.记录患者的平均手术时间和术中出血量,以及术后并发症,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做相应的评价,肘关节则采用MEPI评分标准评估.结果 8例患者采用胸三角肌入路,5例患者采用外侧三角肌入路,手术用时60～180分钟,平均96.5分钟,术中出血100～400ml,平均238.5ml.所有患者均获得11～23个月的随访,平均16.9个月,骨折临床愈合时问7～17周,甲均11.6周.术后未出现桡神经损伤症状,1例患者出现前臂外侧皮神经支配区域感觉减退,3月后恢复,另有1例并发同侧肩周炎,经综合康复治疗4月后好转.参照Constant-Murley肩关节评分标准,患侧为65～91分,平均79分,与健侧的百分比为75.8%～95.6%,平均87.6%.总体Constant-Murley评分优良12例,满意1例.参照肘关节MEPI评分标准,本组为90～100分,平均96.9分,优良率100%.结论 长型PHILOS接骨板扭转塑形后可以避开三角肌止点,减少对软组织损伤,同时避免医源性桡神经损伤的可能,适用于累及肱骨近端的肱骨中上段骨折的微创手术治疗.
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