锁定钢板治疗肱骨近端Neer三、四部分骨折

Locking plate in the treatment of Neer three-and four-part proximal humeral fractures

目的探讨肩袖牵拉复位、缝合固定大小结节联合肱骨近端锁定钢板(PHILOS)治疗肱骨近端Neer三、四部分骨折的临床疗效。方法采用肩袖牵拉复位、缝合固定大小结节联合PHILOS治疗27例肱骨近端Neer三、四部分骨折患者。末次随访时记录患者关节活动度及Constant-Murley评分。结果患者均获得随访,时间13~22个月。骨折均愈合。末次随访时,关节活动度:前屈上举147.9°±17.4°,外展146.1°±15.6°,外旋44.6°±9.0°,内旋82.6°±6.0°;Constant-Murley评分为75~98分,优17例,良10例,优良率27/27。无术后感染、肱骨头坏死、螺钉穿出关节面及钢板松动等并发症发生。结论采用肩袖牵拉复位、缝合固定大小结节联合PHILOS固定治疗肱骨近端Neer三、四部分骨折可获得较为满意的疗效。

Objective To investigate the clinical outcome of rotator cuff pull reduction and humeral greater and lesser tuberosity suture fixation combined with proximal humeral internal locking system(PHILOS)for treatment of Neer three-and four-part proximal humeral fractures.Methods Twenty-seven patients with Neer three and four-part proximal humeral fractures were treated with rotator cuff pull reduction and suture fixation combined with PHILOS.At the last follow-up,the patient’s joint mobility and the Constant-Murley score were recorded.Results A follow-up of 13~22 months for all patients showed that all fractures were healed.At the last follow-up,the joint activity:anteflexion and up lift was 147.9°±17.4°,abduction 146.1°±15.6°,external rotation 44.6°±9.0°,internal rotation 82.6°±6.0°.Shoulder joint function assessed by Constant-Murley score was 75~98 points,the result was excellent in 17 cases,good in 10 cases,with an excellence-good rate of 27/27.There were no complications such as postoperative infection,humeral head necrosis,screws penetrating the joint surface,and loosening of the plate.Conclusions Rotator cuff pull reduction and suture fixation combined with PHILOS can attain satisfactory clinical outcome for Neer three-and four-part proximal humeral fractures.