软骨下骨立体支撑型肱骨近端锁定钢板治疗骨质疏松型肱骨近端骨折

Osteoporotic fracture of proximal humerus treated with Spatial Subchondral Support（S3） locking plate of proximal humerus

目的探讨软骨下骨立体支撑型（s3）肱骨近端锁定钢板治疗骨质疏松型肱骨近端骨折的技术要点及疗效。方法2010年7月至2011年7月共收治21例骨质疏松型肱骨近端骨折患者，男12例，女9例；年龄58—80岁（平均66．0岁）。骨折根据Neer分型系统分型：三部分骨折13例，四部分骨折8例。合并肩关节脱位2例。常规行肩关节CT平扫及三维重建以明确骨折类型及受累情况，于伤后2．7d（平均4．0d）行切开复位s3肱骨近端锁定钢板内固定。术后定期复查x线片，记录相关并发症，并采用改良Constant—Murley评分、疼痛视觉模拟评分（VAS）评定疗效。结果18例患者术后获12～24个月（平均18．0个月）随访。骨折愈合时间为10～14周（平均12．0周）。末次随访时改良Constant．Murley评分为62．96分（平均80．2分），VAS评分为0—6分（平均1．5分）。2例四部分骨折患者分别于术后10、13个月X线片示肱骨头缺血性坏死，伴中度疼痛，予保守治疗后症状缓解。未见伤口感染、内固定失败、内固定物撞击等并发症。结论采用s3肱骨近端锁定钢板治疗骨质疏松型肱骨近端骨折固定效果稳定，且可避免钢板引起的撞击，是一种安全、有效的治疗方法。

Objective To evaluate the surgical techniques and clinical outcomes of treating osteo- porotic fracture of proximal humerus with Spatial Subchondral Support （$3） locking plate of proximal humerus. Methods From July 2010 to July 2011, 21 patients with osteoporotic fracture of proximal humerus, 12 males and 9 females, were treated in our department. They were 66.0 years old on average （from 58 to 80 years old） . According to the Neer classification system, 13 cases were 3-part fractures, 8 4-part fractures, and 2 combined with shoulder dislocation. All cases were evaluated carefully with routine CT scans pre-operatively to define the type of fracture and the involvement of articular surface. Open reduction and internal fixation with $3 locking plate of proximal humerus was performed 2 to 7 days after injury （average, 4. 0 days）. Regular X-ray follow-ups were taken and complications recorded as well. Overall function evalu- ation was carried out according to the modified Constant-Murley score system （CMS） and visual analogue scale （VAS） . Results The 18 cases were followed up for a mean duration of 18.0 months （from 12 to 24 months）. No complications of wound infection, implant failure or impingement were observed daring the fol- low-ups. Bone union was achieved after an average of 12.0 weeks （from 10 to 14 weeks） . On average, the Modified CMS score was 80. 2 and the VAS score 1.5. At the post-operative 10th and 13th months, X-ray manifested avascular necrosis of the humeral head respectively in 2 cases of 4-part fractures, who suffered from moderate pain which was relieved after conservative treatment. Conclusion Fixation with $3 locking plate of proximal humerus is a safe and effective treatment of osteoporotic fracture of proximal humerus, be- cause it is rigid and avoids plate-related impingement.