Philos系统治疗老年骨质疏松性肱骨外科颈骨折

Clinical Effect of Fixation of the Older Osteoporosis Fractures of Humeral Surgical Neck Using the Locking Plate-Philos

目的探讨经肌间隙入路应用Ph ilos系统治疗老年骨质疏松性肱骨外科颈骨折的疗效。方法自2008年3月到2010年12月,采用Ph ilos系统经三角肌胸大肌间隙入路治疗老年骨质疏松性肱骨外科颈骨折23例。N eer分型,二部分骨折4例,三部分骨折13例,四部分骨折6例。其中植骨19例(自体骨13例,异体骨6例),肩袖损伤者给与修复。术前术后均行抗骨质疏松及促进骨折愈合治疗,早期功能锻炼。结果术后X线显示钢板螺钉位置良好,骨折复位满意,无腋神经血管损伤,4例出现脂肪液化。随访6～24个月(平均9.8个月),无骨折不愈合及肱骨头坏死病例,2例发生异位骨化,无内固定松动断裂及伤口感染等发生。根据Constan t评分,本组优11例,良8例,可4例,优良率82.6%。6个月后与治疗前骨密度值比较均有不同程度好转,但无统计学意义(P>0.05)。结论 Ph ilos系统具有协助复位、置钉角度科学、固定可靠、便于恢复局部软组织结构、可早期行功能锻炼等优点,较适用于老年骨质疏松粉碎性肱骨外科颈骨折。

Objective To investigate the clinical effect of inter fixation of the older osteoporosis fractures of humeral surgical neck using the locking plate-Philos（Proximal humeral internal locking system） via the deltopctoral-groove approach.Methods Reduction and locking plate-Philos fixation were done via deltopctoral-groove approach on 23 cases with the older osteoporosis humeral surgical neck fractures from March 2008 to December 2010.Bone graft was applicated on 19 of 23 cases and the rotator cuff was repaired simultaneously if damaged.The medicine of anti-osteoporosis and promoting fractures healing were applied after be in hospital.Shoulder joint passive exercises was performed at 2 days after Operation,actived exercises were done gradually 2 weeks after operation.According to Neer classification,there were 4 cases of two parts fracture,13 cases of three parts fractures and 6 cases of four parts fractures.Results The postoperative radiographs verified good position of plate and screws,with satisfactory fracture reduction and no neurovascular injury（such as axillery nerve and humeral artery） happened.Fat liquefaction happened on 4 cases.Follow-up for 6~24 months（average 9.8 months） showed no necrosis of humeral head,no delayed-union and un-union happen,2 cases heterotopic ossification.According to Constant Score：the rate of excellent good was 82.6%.After 6 months,the bone mineral density SD value of patients were higher than the first BMD SD value,but this was not statistically significant（P〉0.05）.Conclusion Locking plate-Philos can firmly fixe the fractures of humeral surgical neck and possessed such advantages as assistance of reduction,early exercises and less disturbance of the blood supply.This plate showed good results for fractures of humeral surgical neck,especially communited fractures and older osteoporosis patients.