锁定加压钢板在不稳定肱骨近端骨折中的运用

Application of the Locking Compression Plates in the Treatment of Unstable Proximal Humeral Fractures

目的探讨锁定加压钢板治疗不稳定肱骨近端骨折的方法及疗效。方法自2007年2月～2010年3月,对46例肱骨近端Neer 2型以上不稳定骨折患者,采用肱骨近端骨折锁定加压钢板治疗。其中男18例,女28例,平均年龄51.3(32～84)岁。根据Neer分类,二部骨折21例,三部分骨折19例,四部分骨折6例。结果经术后平均14.5(10～22)个月随访,有1例患者术后5 d发生内固定失效,予再次手术后获骨性愈合。应用Neer疗效评分系统进行评定,优21例,良16例,可7例,差2例,优良率80.4%。结论肱骨锁定加压钢板的螺钉锁定作用,能够提高对肱骨近端不稳定骨折的固定效果,做到骨折愈合与功能锻炼同步。但应注意对锁定加压钢板的合理操作,尽量避免因操作错误引起的内固定效果不佳。只有掌握锁定加压钢板的操作要点并加以灵活运用才能减少和正确处理各种术中失误。

Objective To discuss the efficacy in the treatment of unstable proximal humeral fracture with the locking compression plates（LCP）.Methods Forty-six patients（18 male and 28 female） with unstable proximal humeral fracture were treated with LCPs from February 2007 to March 2010.The average age of the patients was 51.3 years old（from 32 to 84 years old）.According to Neer classification,21 cases were two-part fractures,19 cases were three-part fractures and 6 cases were four-part fractures.Results All the cases were followed up for 14.5（10~22） months.According to the Neer shoulder scoring system,the excellent and good rate was 80.4%（37/46）.1 patient failed in the first LCP fixation and got reoperation later.Conclusions The locking screw of LCP can improve the fixation of the unstable fractures of proximal humerus,getting fracture healing and functional exercise for synchronization.But attention should be paid to reasonable operation of LCP to avoid poor fixation caused by operational errors.Only effective operation and flexible use of LCP can reduce and correctly handle these errors.