PHILOS钢板治疗老年肱骨近端冠状面骨折初探

Surgical Treatment for Coronal displaced Proximal Humeral Fractures in Elderly Patients using PHILOS Plate-Preliminary Exploration

目的:探讨采用PHILOS钢板治疗肱骨近端冠状面骨折手术治疗的早期临床疗效。方法:对2005年4月至2014年5月我院收治的9例肱骨近端冠状面骨折患者予以切开复位钢内固定治疗,采用DASH评分,生活质量评价量表(SF-36),Constant-Murley评分以及加利福尼亚洛杉矶大学肩关节评分(UCLA Score)对患者进行功能评价。结果:纳入患者平均年龄为63.5±3.2岁(53~82岁),男性2例,女性7例,根据Neer分型,单纯二部分骨折5例,二部分骨折伴肩关节脱位4例。术后随访12~22个月,平均14.2±3.2个月。9例患者均得到随访。所有患者肱骨近端骨折均愈合,骨折愈合时间12~18周,平均12.7±2.5周,末次随访时,7例无明显肩关节疼痛,2例有轻微疼痛,Constant评分平均87.0±4.2分;DASH评分平均20.9±2.5分,加州大学肩关节评分系统(UCLA)平均31.3±2.1;SF-36评分平均分,影像学结果显示:末次随访肱骨头高度平均丢失1.7±0.4 mm,颈干角度平均为126±13°。结论:采用切开复位钢板内固定对于肱骨近端冠状面骨折早期临床疗效良好,远期疗效有待进一步评价。

Objective： To access the effectiveness of surgical treatment for the coronal displaced proximal humeral fractures in el- derly patients using PHILOS plate. Methods： From 2005.4 to 2014.5, 9 cases of coronal displaced proximal humeral fractures were included, and underwent open reduction and internal fixation （ORIF） surgery. Postoperative evaluation was performed according to the DASH （Disabilities of arm, shoulder ＆ hand） Score, Short form health survey （SF-36）, Constant Shoulder Score and UCLA Shoulder rating scale. Results： The mean age of the included patients was 63.5±3.2 （53～82）, 2 cases were male and the other 7 were female. According the Neer Classification, 5 cases were diagnosed as Two-part fi＇acture, 4 cases with two-part fracture and dislocation. The mean follow-up time was 14.2± 3.2（12～22）. Solid bone union was detected in all cases, the mean bone union time was 12.7± 2.5 months （12～18）. At last follow-up, 7 cases obtained satisfied range of motion （ROM） without pain, while 2 presented mild pain. Constant score averaged 87.0± 4.2, DASH score averaged 20.9± 2.5, the mean UCLA score was 31.3± 2.1 and the SF-36 score averaged 72.4±4.2. On the other hand, the radiograph indicated a mean height loss of 1.7 mm at last follow-up, and the Neck-shaft angle averaged at 126±13°. Conclusions： Open reduction and Internal fixation with plates is a ideal approach for the specific fracture pattern, long-term effectiveness needs further accessment involving larger population.