应用小切口PHILOS钢板治疗肱骨近端骨折效果评价

Small incision PHILOS plate fixation in treatment of proximal fracture:a recent outcome analysis

[目的]探讨PHILOS钢板有限切开治疗肱骨近端骨折的方法与疗效。[方法]应用PHILOS肱骨近端解剖型钢板有限切开(肱骨近端前外侧入路)治疗肱骨近端骨折54例。其中男31例,女23例,年龄48～79岁,平均62岁。根据Neer分型二部分骨折19例(解剖颈骨折9例,外科颈骨折8例,大结节骨折2例);三部分骨折25例;四部分骨折10例(骨折伴肩关节脱位2例)。[结果]54例患者经18个月的随访,54例均愈合,影像学提示骨愈合发生在10周左右,有1例发生轻度肩峰撞击,1例四部分骨折的患者发生部分肱骨头坏死。根据术后肩关节Neer评分法,优27例,良23例,可4例,优良率达92.6%。[结论]肱骨近端骨折应用PHILOS钢板固定,重视内侧皮质复位内侧柱的重建,手术创伤小,复位简便,骨折愈合顺利,肩关节功能恢复好,未发现术后明显复位丢失、钉板松动和断裂病例,为目前治疗肱骨近端骨折的较理想的方法。

[ Objective] To investigate the clinical efficacy of small incision PHILOS plate fixation in treatment of proximal fracture. [ Method] Proximal humerus anatomic plate PHILOS limited incision （anterolateral proximal humerus） procedure was carried ou in 54 cases of proximal humeral fractures,with 31 males and 23 females,aged 48 79 years （mean 62 years）. Ac cording to Neer classification, there were twopart fractures in 19 patients （anatomical neck fracture in 9 cases, surgical neck fractures in 8 cases, greater tubercle fracture in 2 cases）, threepart fracture in 25 cases, fourpart fracture in 10 cases （fracture with dislocation in 2 cases）. [ Result] All patients received follow up for 18 months. Fracture healed in all patients. Bone heal ing happened at 10 weeks after operation according to radiology analysis. Mild impingement was found in 1 case. Partial humer al head necrosis was found in 1 fourpart fracture case. According to Neer classification, there were excellent result in 27 cases, good in 23 ,fair in 4 ,the good to excellent result rate was 92.6%. [ Conclusionl Small incision PHILOS plate fixation has ad vantages of less trauma, simple replacement, early bone healing, and smooth recovery of shoulder joint, in treatment of proximal fracture. No obvious loss of reduction, nail loosening or broken has been found. It is an ideal method for treatment of proximal fracture.