微创技术置入PHILOS钢板治疗肱骨干近端骨折

Application of minimally invasive PHILOS in treatment of proximal humeral fractures

目的评价微创接骨板固定（MIPO）技术置入PHILOS（proximal humeral internal locking system）治疗肱骨干近端骨折的临床效果。方法自2008年11月-2009年8月，采用MIPO技术置入PHILOS钢板治疗23例肱骨干近端移位骨折。结果本组获随访6～17个月，平均11．3个月。X线片示22例于术后6个月内骨折达骨性愈合；1例因内固定松动发生延迟愈合，但无临床症状，于术后9个月骨折愈合，功能恢复至可。术后半年1例发生肩关节撞击征，取出内固定行功能锻炼后功能恢复至可。采用Constant—Murley评分方法评定疗效：优11例，良10例，可2例，优良率91．3％。结论采用MIPO技术置入PHILOS钢板治疗肱骨近端骨折是一种良好的方法．减少骨不连发生率．有利于肩关节早期功能恢复。

Objective To evaluate the clinical and radiological outcomes of MIPO （minimally invasive plate osteosynthesis） with PHILOS （proximal humeral internal locking system） in the treatment of proximal humeral shaft fracture. Methods From Nov. 2008 to Aug. 2009, 23 patients with displaced fractures of the proximal humeral shaft were recruited. Results All patients were followed up for 6-17 months, with an average of 11.3 months. Radiological examination revealed bony union within 6 months in 22 cases. There＇s one case delayed union, which remained a asymptomatic and eventually healed at 9 months postoperative with acceptable Constant-Murley score and there＇s other one case of shoulder impingement diagnosed at 6 months postoperative. After implant removal, they all achieved an acceptable Constant-Murley score. According to Constant- Murley scoring system, there were 11 excellent, 10 good and 2 acceptable results, the excellent and good rate was 91.3%. Conclusion MIPO technique using PHILOS is an effective method to treat proximal humeral shaft fractures, which reduces rate of bone nonunion and facilitates functional recovery of the shoulder joint. During the surgery, it is important to achieve good fracture reduction and avoid complications.