有限切开长型锁定加压钢板治疗复杂性骨质疏松性肱骨干骨折的效果

Effect of limited incision approach locking plate internal fixation in the treatment of complex osteoporotic humeral shaft fractures

目的探讨应用长型肱骨近端内固定锁定系统(PHILOS)治疗复杂性骨质疏松性肱骨干骨折的临床效果。方法选择2014年7月~2017年3月新疆医科大学第五附属医院收治的28例肱骨干骨折(AO分型:B型9例,C型19例)患者,所有患者均应用有限切开长型PHILOS钢板插入治疗,术后通过X线评估骨折愈合及内固定情况,肩、肘关节功能分别采用美国加州大学肩关节评分(UCLA)和Mayo评分评价。结果术后随访骨折都顺利愈合,术后无医源性桡神经损伤,骨折愈合时间12~36周[平均(22.5±6.8)周]。肩关节外展80°~110°[平均(102.2±3.2)°],后伸20°~40°[平均(38.0±1.1)°],前屈150°~170°[平均(165.3±2.1)°];肘关节伸直-5°~10°[平均(8.0±0.9)°],屈曲120°~140°[平均(132.2±2.4)°]。肩关节功能UCLA评分为优26例,良2例。肘关节功能Mayo评分为优26例,良2例。结论有限切开长型PHILOS是治疗复杂性、骨质疏松性肱骨干骨折的一种有效、安全的方法。

Objective To explore the clinical effect of long proximal humeral locking system（PHILOS） in the treatment of complex osteoporotic humeral shaft fractures. Methods From July 2014 to March 2017, in Fifth Affiliated Hospital of Xinjiang Medical University, 28 patients with humeral shaft fractures（AO type： 9 cases of type B, 19 cases of type C）treated with limited incision and long type PHILOS plate insertion were selected. The fracture healing and internal fixation were evaluated by X-ray, and the function of shoulder and elbow joint was evaluated by University of California at Los Angeles（UCLA） score and Mayo score respectively. Results All fractures healed smoothly. There was no iatrogenic radial nerve injury. The healing time was 12-36 weeks [by an average of（22.5 ±6.8） weeks]. Abduction of shoulder joint ranged 80°-110° degrees [by an average of（102.2±3.2）°], extending 20°-40° degrees [by an average of（38.0±1.1）°], and flexion 150°-170° [by an average of（165.3±2.1）°]. The elbow joint extends-5°-10° [by an average of（8.0±0.9）°], and the flexion was 120°-140° [by an average of（132.2±2.4）°]. The shoulder joint function, 26 cases were excellent and 2 cases were good according to UCLA criteria. For the elbow joint function, 26 cases were excellent and2 cases were good according to Mayo criteria. Conclusion Limited open long PHILOS is an effective and safe method for the treatment of complex and osteoporotic humeral shaft fractures.