肱骨近端锁定钢板治疗肱骨近端4部分骨折

Proximal humeral locking plate for the treatment of four-part proximal humeral fracture

背景:以往对肱骨近端4部分骨折患者行切开复位内固定时常使用非锁定的解剖钢板,难以获得稳定的固定,固定后并发骨折再移位及肱骨头坏死的概率相对较高。目的:观察肱骨近端锁定钢板治疗肱骨近端4部分骨折的临床疗效。方法:肱骨近端4部分骨折的患者72例,其中无肱骨头脱位40例,肱骨头脱位32例,均给予切开复位、肱骨近端锁定钢板锁定系统固定,固定后3周内给予肩关节制动,之后逐渐开始功能锻炼。定期随访,通过Neer评分评价肩关节的功能。结果与结论:末次随访3,6,9,12,18,≥24个月的患者数分别为6,13,31,9,8,5例。末次随访≥9个月的53例,骨折愈合率达98%(52/53),Neer评分中级以上达85%(45/53),肱骨头坏死率6%(3/53)。X射线检查显示3例均为固定前肱骨头脱位患者,肩峰撞击综合症发生率9%(5/53),无内固定松动、螺钉断裂。固定前肱骨头脱位固定后肱骨头坏死和Neer评分与固定前无肱骨头脱位比较差异无显著性意义。说明肱骨近端锁定钢板治疗肱骨近端4部分骨折利于骨折块复位,固定牢靠,固定后肩关节功能恢复良好,并发症较少。

BACKGROUND： Non-locking anatomical plate is commonly used for open reduction and internal fixation for the treatment of four-part proximal humeral fracture, but it has the high probability of fracture re-displacement and humera head necrosis after fixation. OBJECTIVE： To observe the clinical results of proximal humeral locking plates fixation for the treatment of four-part proximal humeral fracture. METHODS： Seventy-two patients with four-part proximal humeral fracture were included, 32 patients with dislocation of the humeral head and the other 40 patients without, and all patients were treated with open reduction and fixation with proximal humeral locking plates. Shoulder＇s movement was restricted within 3 weeks after surgery, and then gradually began to perform the functional exercise. All patients were followed-up regularly and Neer scores were recorded to evaluate the function of shoulder after union of fractures. RESULTS AND CONCLUSION： At the time of final followed-up, 6 patients were followed-up for 3 months, 13 patients were followed-up for 6 months, 31 patients for 9 months, 9 patients for 12 months, 8 patients for 18 months and 5 patients for at least 24 months. Fifty-three patients were followed-up for at least 9 months, the rate of fracture union was 98% （52/53）, Neer scores with intermediate and above the intermediate level was 85% （45/53）, humeral head osteonecrosis was 6% （3/53）, and all the 3 patients were preoperative humeral head dislocation, subacromial impingement syndrome was 9% （5/53）, and no screw loosing or fracture occured. There were no significant differences of Neer score and humeral head necrosis between patients with and without preoperative humeral head dislocation. The application of proximal humeral locking plate for the treatment of four-part proximal humeral fracture is helpful to the reduction of four-part fractured fragments and its fixation is stable. The recovery of postoperative shoulder functions is satisfactory and low rate of complications can be obtained following locking plate treatment of four-part fracture.