锁定钢板置入治疗肱骨近端复杂骨折:23例技术操作特点

Locking steel plate therapy for complex fracture of the proximal humarus:Technique operation in 23 cases

目的:探讨可能影响锁定钢板置入治疗肱骨近端复杂骨折稳定性的相关因素。方法:①对象:江苏省海门人民医院自2003-08/2006-06采用切开复位锁定钢板内固定法治疗肱骨近端Ⅲ型骨折和Ⅳ型骨折23例。Ⅲ型骨折14例,Ⅳ型骨折9例。②方法:经三角肌胸大肌间入路,钝性分开三角肌,复位时尽量减少对骨折血运的破坏,将锁定钢板置于肱骨的侧方,大结节下方5mm处,克氏针临时固定,锁定螺钉固定钢板,将移位的大小结节固定于钢板上。术后患肢三角巾悬吊胸前位固定。术后随访9～26个月,其中2例患者随访9个月,5例患者随访12个月,1例患者随访15个月,11例患者随访18个月,2例患者随访24个月,2例患者随访26个月。③评估:定期复查X线片,观察材料及宿主反应。术后功能评价采用Neer评分,以90～100分为优,80～89分为良,70～79为可,小于70分为差。结果:①术后X线片结果:骨折对位对线均良好,钢板螺钉位置好。②Neer评分结果:优12例,良9例,可2例。③骨折愈合情况:术后12～15d切口拆线均一期愈合。骨折愈合时间3～6个月,平均4.5个月。④材料与组织的生物相容性能:23例患者术后未见内固定物腐蚀、松动、断裂;无切口感染、局部炎症反应、排异反应;患者血常规正常。结论:锁定钢板置入有高度的稳定性,治疗肱骨近端骨折,尤其是粉碎性及骨质疏松性骨折较理想。导致不稳定性的因素有技术操作、适应证、材料反应及宿主反应等问题。

AIM： To study the related factors of influencing the stability of locking Steel plate in the treatment of the complex fractures of proximal humerus. METHODS： （1）Object： A total of 23 cases with proximal humeral fractures were treated with open reduction locking proximal humeral plate from August 2003 to June 2006 in Haimen People＇s Hospital, including 14 cases with Ⅲ fracture and 9 cases with Ⅳ fracture. （2）Method： Reduction and fixation were done via deltopectoral groove approach to reduce the breakage of the blood circulation on the fracture while reduction. The steel plate was targeted beside the humerus, 5 mm under the greater nodule, and was fixed by Kirschner needle, then the bolt was locked and the steel plate was fixed, at last the dislocated nodules were fixed at the steel plate. After operation, the lesioned limb was hanged before the chest to fix with the triangular bandage. The follow-up period was 9-26 months, 9 months in 2 sufferers, 12 months in 5 sufferers, 15 months in 1 sufferer, 18 months in 11 sufferers, 24 months in 2 sufferers, and 26 months in 2 sufferers.（3）Evaluation： Periodical reexamination of X-ray slice was conducted to observe the reaction to the material and sufferers. Function was evaluated according to Neer scoring system, with 90-100 scores as excellent, 80-89 scores as good, 70-79 scores as fair, and less than 70 scores as bad. RESULTS： （1）Result of X-ray slice： Both the line and contraposition of bone fracture were good, and the steel plate and bolt were also fixed well. （2）The result of Neer scores showed that 12 cases were excellent, 9 cases were good, and 2 cases were fair.（3）Healing of bone fracture： All the cases expenenced bone union within 12-15 days postoperation. The healing time was 3-6 months, average 4.5 months. （4）Biocompatibility of materials and tissues： In 23 sufferers, no internal corrosion, loosening or breakdown occurred; no incision infection, local inflammation or rejection reaction appeared; all the patients were normal by the blood routine test. CONCLUSION： Due to the high stability, locking proximal humeral plate is effective for proximal humeral fracture, particularly for osteoporosis and comminuted fractures. The related factors of unsteady are technique operation, indication, the responses to the material and the sufferer, etc.