肱骨近端锁定板(LPHP)治疗肱骨近端粉碎性骨折的回顾性临床研究

Retrospective clinical study of treatment with Locking Proximal Humeral Plate (LPHP) for Neer III and Ⅳ Proximal Humeral Fracture

目的通过比较肱骨近端锁定板（LPHP）与肱骨近端解剖板（APHP）治疗肱骨近端粉碎性骨折,回顾性评价LPHP的临床效果。方法 2007年6月-2011年9月对109例NeerⅢ、Ⅳ型肱骨近端骨折患者资料回顾性分析,根据内固定方式分为两组,LPHP组（59例）和APHP组（50例）,对两组患者的手术时间、出血量、骨折愈合时间、骨折愈合率、肱骨头后倾角丢失、肩关节功能优良率及术后并发症等进行比较分析。结果 LPHP组和APHP组平均手术时间分别为90.3±10.6min、100.5±12.6min,术中平均出血量分别为160.8±40.2ml、175.2±45.1ml,两组比较有统计学意义（P〈0.05）。两组患者均获得随访,随访时间14-20个月,平均16个月,104例获得临床骨性愈合,其中LPHP组58例,APHP组46例,两组比较有统计学意义（P〈0.05）,LPHP组骨折愈合时间为10-12周,APHP组为12-18.5周,两组比较有统计学意义（P〈0.05）。3例发生肱骨头坏死,其中LPHP组0例,APHP组3例,术后18个月较术后即刻LPHP组肱骨头后倾角丢失约5.6°,APHP组约7.6°,两组比较有统计学意义（P〈0.05）。术后肩关节功能评定根据Neer评分标准,LPHP组优53例、良5例、差1例,APHP优20例、良17例、差13例,两组比较有统计学意义（P〈0.05）。结论采用LPHP治疗肱骨近端粉碎性骨折具有创伤小、操作简单、固定可靠,骨折愈合快,术后恢复快,并发症少。

Objective To retrospectively analyze the results of treatment with Locking Proximal Humeral Plate（LPHP） for Neer Ⅲ and Ⅳ Proximal Humeral Fracture in comparison with anatomical proximal humeral plate（APHP）.Methods In Jun 2007to sep 2011,109 cases of Neer III and ⅣProximal Humeral Fracture with Locking Proximal Humeral Plate（LPHP） were analyzed retrospectively and the treatment effect was observed.LPHP was used in 59patients（group A）,APHP in 50 patients（group B）.The clinical outcomes were compared between the 2 methods,including operation time,the volume of blood loss,fracture healing time,rate of fracture healing,the head of the humerus caster Angle loss,Neer score and complications.Results The operation time averaged 90.3±10.6min,100.5±12.6min in group B.the volume of blood loss averaged160.8±40.2ml in group A.175.2±45.1ml in group B（P〈0.05）.All cases were followedup（mean 16months,range 14-20months）.Bone union occurred in 58 cases in group A,in 46 cases in group B（P〈0.05）.Fracture healing time was 10-12weeks in group A,12-18.5 weeks in group B（P〈0.05）.Humeral head necrosis occurred in 3 cases in group B.The head of the humerus caster Angle loss was 5.6°in group A,and 7.6°in group postoperative 18 months more postoperative instantly（P〈0.05）.By neer scoring system,in group A find 53 excellent cases,5 good ones,1fair one,with 98.3% in excellent and good rate,and in group B find 20 excellent cases,17good ones,13 fair ones,with 74% in excellent and good rate（P〈0.05）.Conclusion It is an idealmethod to treatunstable Neer III and Ⅳ Proximal Humeral Fracture with Locking Proximal Humeral Plate.The procedure is convenient and the fixation is stable,leading to fast fracture healing,good reovery and limited com plications.