肱骨近端锁定接骨板治疗肱骨近端粉碎性骨折

Locking proximal humerus plate treating comminuted proximal humeral fractures

目的探讨应用肱骨近端锁定接骨板（locking proximal humerus plate，LPHP）内固定治疗肱骨近端粉碎性骨折的可行性和疗效。方法对2004年9月至2007年9月收治并获得随访的18例肱骨近端骨折进行回顾性分析，其中男7例，女11例，年龄25～79岁，平均52．8岁。所有骨折均按Neer分型：二部分骨折4例，三部分骨折6例，四部分骨折8例，其中骨质疏松7例。手术经三角肌、胸大肌间隙入路，采用肱骨近端锁定接骨板对骨折进行固定，对其中6例存在严重骨缺损患者进行自体骨植骨。结果随访8—24个月，平均12．5个月，骨折均愈合。采用Neer肩关节功能评分标准评定：优6例，良7例，中3例，差2例，优良率为72．2％。合并内翻畸形1例，肱骨头缺血性坏死2例（术后1年行人工肱骨头置换术），肩关节创伤性关节炎2例，骨折延迟愈合1例。结论肱骨近端锁定接骨板内固定是一种有效的适宜于肱骨近端粉碎性骨折的治疗方法，既能实现对骨折断端的稳固固定作用，又避免了对骨块附着软组织和骨膜的过多剥离，可有效地遏制肱骨头的缺血性坏死。

Objective To evaluate the feasibility and results of internal fixation with locking proximal humerus plate （LPHP） for comminuted proximal humeral fractures. Methods Eighteen cases of closed proximal humeral fractures were treated in our department from September 2004 to September 2007, including 7 males and 11 females, aged 25 - 79 years （ mean 52.8 years ）. All of them were followed up and retrospective reviewed. According to Neer classification ,4 cases were classified into two - part fractures ,6 into three -part fractures, and 8 into four -part fractures. Seven cases had osteoporosis. Reduction and fixation was done via dehopectoral - groove approach, using locking proximal humerus plate internal fixation. Of all,6 cases having bone defects were treated with autografts. Results During a follow - up period of 8 to 24 months （average 12.5 months） ,all fractures were healed. According to the Neer shoulder score ,6 cases were assessed as excellent ,7 as good ,3 as fair, and 2 as poor. The good- to- excellent rate was 72.2%. There was 1 case of varus abnormity ,2 cases of ischemic osteoneerosis （ Shoulder hemiarthroplasty was performed one year postoperation） ,2 cases of traumatic arthritis of shoulder joint, and 1 case of delayed union. Conclusion Internal fixation with locking proximal humerus plate is a safe and effective way to proximal humeral fractures. Good stability was obtained and the aggressive impairment of soft tissue and periosteum around the fracture was avoided. This technique could also promote bone healing and prevent ischemic osteonecrosis of head of humerus.