锁定钢板治疗肱骨近端骨折及内侧支撑的意义

Treatment of proximal humeral fractures with locking plate the importance of medial support

目的观察锁定钢板治疗肱骨近端骨折的效果以及内侧支撑对其影响。方法2003年2月-2加8年3月，收治肱骨近端骨折37例。其中男15例，女22例；年龄为21-81岁，平均65．6岁。60岁以下8例，60岁以上29例。自行摔倒伤22例，高处坠落伤9例，车祸伤6例。根据Neer分型：二部分骨折13例，三部分20例，四部分4例。所有患者均应用锁定钢板（proximal humeral internal locking system，PHILOS）治疗。结果术后33例获得12～48个月的随访（4例失访），平均18．6个月。骨折均愈合，愈合时间平均为10周。无内固定失效。根据Constant评分标准评定，优良率为81．8％。结论锁定钢板是治疗肱骨近端骨折的有效方法，肱骨头部内下方的有效支撑以及减少软组织剥离是手术成功的关键。

Objective To evaluate the results of locking plate fixation for the treatment of proximal humeral fractures and the effect of medial support of the humeral head. Methods From February 2003 to March 2008, 37 cases of proximal humeral fractures were treated. There were 15 males and 22 females. The age of this group ranged from 21 to 81 years, with an average of 65.6 years. There were 8 patients who were younger than 60 and 29 older than 60. Causes of the fractures included falling from bicycles in 22 cases, falling from a height in 9 cases and traffic accident in 6 cases. According to Neer classification, there were 13 cases of two-part fractures, 20 eases of three-part and 4 eases of four-part fracture. All the fractures were treated with locking plate （Proximal Humeral Internal Locking System, PHILOS ）. Results Postoperatively 33 cases were followed up for 12 to 48 months with an average of 18.6 months. Four cases were lost to follow up. Bone union was achieved in all cases, with the mean healing period of 10 weeks. According to Constant scoring, the excellent and good result rate was 81.8%. Conclusion Locking plate is an effective implant for treating proximal humeral fractures. Mechanical support of inferior-medial region in the humeral head to maintain the reduction and less soft tissue striping of the fracture site are important for the success of the surgery.