影响锁定板治疗肱骨近端骨折效果的因素

The affecting factors of Prognosis for Patient used locking plates in proximal humeral fractures

目的通过对采用锁定钢板治疗肱骨近端骨折病例的回顾性研究,以评价患者年龄及骨折类型因素对手术治疗效果的影响程度。方法 2002-01～2007-02,31例肱骨近端骨折患者入选研究队列,其中女23例,男8例,平均61.6岁(19～86岁);采用AO分型,A型8例,B型15例,C型8例,均应用Philos锁定钢板进行切开复位内固定手术治疗;术后均连续随访其X线表现及功能变化,X线平均随访12个月(10～15月),DASH(Disabilities of the Arm,Shoulder,and Hand Outcome Measure)问卷调查至少18个月(18～60月)。结果术后18个月DASH评分均值A型25.3分,B型21.4分,C型22.7分,组间差异无统计学意义(P>0.05);>65岁的患者评分均值为21.5分,<65岁的患者则为27.5分,2组间存在显著性差异(P<0.05);术后颈干角>90°的患者评分均值为20.4分,<90°的患者为24.3分,2组间差异无统计学意义(P>0.05);7例患者进行了二次手术以促进骨折愈合,但1a后96%的患者骨折达到了临床及放射学愈合。结论应用锁定钢板治疗肱骨近端骨折对于任何骨折类型均取得了令人满意的骨折愈合及功能恢复,对于高龄患者其功能康复不如年轻病人,较高的二次手术率应引起注意。

Objective This study was undertaken to evaluate the efficacy of a proximal humeral locking plate,and to specifically study the effect of patient age and fracture type on outcome. Methods Thirty - one cases of proximal humeral fractures fixed using the proximal humeral interlocking ( Philos) plate were reviewed. From May 2003 to May 2007 31 patients with displaced fractures of the proximal humerus had open reduction and internal fixation with a Philos plate. There were 23 women and 9 men with a mean age of 61. 6 years ( 19 to 86) . Twenty - five of the patients sustained their injury following a fall,5 from a road traffic accident and 1 from direct assault. Fractures were classified with the AO system,there were 8 type A ( extra - articular unifocal) ,15 type B ( extra - articular bifocal) and 8 type C ( articular) fractures. Results Average functional scores ( minimum 18 months post - op) per AO/ASIF fracture type were 25. 3 for type A,21. 4 for type B and 22. 7 for type C. There was no statistically significant difference between groups. Functional score for patients over 65 years of age were significantly inferior ( P < 0. 05) . At final radiologic review ( mean 12 months postop) 30 ( 96% ) of the patients had united. Seven patients ( 22. 5% ) required a second surgical procedure. Conclusion We obtained both good functional results and bone healing with the PHILOS plate irrespective of fracture type,older patients had a poorer outcome. We caution surgeons on the high potential for re-operations with its use.