肩峰下外侧经三角肌入路微创经皮接骨板内固定技术结合PHILOS接骨板治疗肱骨近端骨折

Appication of PHILOS plate in MIPPO for the treatment of proximal humeral fractures

背景：肱骨近端骨折采用保守治疗多不理想，目前多主张手术治疗。目的：探讨肱骨近端骨折的微创手术治疗的效果。方法：采用肩部外侧经三角肌入路，微创经皮接骨板内固定技术（minimally invasive percutaneous plate osteo-synthesis，MIPPO）结合PHILOS接骨板治疗肱骨近端骨折26例，评价疗效。结果：所有患者均获得随访，随访时间为1～12个月，平均（10．5il．1）个月。无伤口感染，复位良好，无内固定松动断裂，无骨折不愈合，无腋神经损伤表现，无肱骨头坏死。肩关节功能采用Neer评分法，优11例，良12例，可3例，总优良率为86．4％。结论：肩峰下外侧经三角肌入路MIPPO结合PHILOS接骨板治疗肱骨近端骨折具有手术时间短，损伤小，术中出血少及术后功能恢复好的优势。

Background： Conservative treatment of proximal humeral fractures is often not satisfying, and at present, surgi- cal treatment is a preferred method. Objective： To investigate the effect of minimally invasive surgery on proximal humeral fractures. Methods： Totally 26 patients with proximal humeral fractures were treated with minimally invasive percutaneous plate osteosynthesis （MIPPO） with PHILOS plate through shoulder lateral small incision. Clinical outcomes were evaluated. Results： The mean duration of follow-up was （10.5±1.1） months （range, 1-12 months） in all the patients. Good reduction and bone union were achieved. No infection, loosening, breakage, axillary nerve injury or necrosis of the head of humerus was found. According to Neer criteria for shoulder joint function, 11 cases got an excellent result, 12 was good, and 3 was fair. The rate of excellent and good was 86.4%. Conclusions： MIPPO combined with PHILOS plate through shoulder lateral surgical approach has the advantage of less operation time, less injury, less intraoperative bleeding and good postoperative recovered function in treatment of proximal humeral fractures.