肱骨近端锁定内固定系统联合微创接骨板技术治疗肱骨近端骨折

Treatment of proximal humeral fracture by proximal humerus internal locking system via minimally invasive plate osteosynthesis

目的探讨肱骨近端锁定内固定系统(PHILOS)联合微创接骨板技术(MIPO)治疗肱骨近端骨折的技术体会和疗效。方法回顾性分析2016年9月至2020年3月湖北省十堰市竹溪县人民医院骨科采用PHILOS钢板联合MIPO技术治疗的30例老年肱骨近端骨折患者资料。男11例,女19例;年龄45~80岁,平均61.0岁。所有患者均采用闭合复位,透视确认骨折复位后,于肩峰下方做小切口,肩袖附着点留置骨科缝线,于结节间沟外侧4 mm插入PHILOS钢板,骨科缝线穿入钢板近端缝线孔备用,PHILOS钢板加压孔拧入加压螺钉,牵拉缝线对抗肩袖应力,维持肱骨头内倾角,复位后用多枚克氏针临时固定,透视证实骨折复位及钢板位置良好,置入锁定螺钉。记录并比较术前与末次随访时患侧肱骨头内倾角。末次随访时依据肩关节功能Neer评分评定疗效,并记录疼痛视觉模拟评分(VAS)和并发症发生情况。结果30例患者术后获6~18个月(平均12个月)随访。所有患者均未发生切口感染及血管神经损伤,无内固定物失效。其中25例患者骨折达解剖复位,5例功能复位,肱骨头内倾角明显改善。末次随访时VAS评分平均1.9分。随访复查X线片示所有患者均达骨性愈合,愈合时间为6~18个月,平均9个月。末次随访时患侧肱骨头内倾角为130°±5°,与术前的90°±11.2°相比明显改善,差异有统计学意义(P<0.05)。所有患者肩关节功能恢复良好。末次随访时依据肩关节功能Neer评分评定疗效:优22例,良6例,中2例。结论PHILOS钢板联合MIPO技术适于肱骨近端骨质疏松性骨折,是一种有效的方法。

Objective To evaluate the efficacy of proximal humerus internal locking system(PHILOS)via the minimally invasive plate osteosynthesis(MIPO)in the treatment of proximal humeral fractures.Methods This retrospective study analyzed 30 elderly patients with proximal humeral fracture who had been treated by PHILOS via MIPO from September 2016 to March 2020 at Department of Orthopedic Surgery,People’s Hospital of Zhuxi County.They were 19 females and 11 males with an average age of 60.96 years(from 45 to 80 years).All patients were treated by closed reduction.After fracture reduction was confirmed by fluoroscopy,a minimally invasive incision was made below the acromion,with a couple of suture wires reserved at the rotator cuff attachments.A PHILOS plate was inserted at 4 mm lateral to the intertubercular sulcus,with the suture wires passing through the proximal suture holes on the PHILOS.After a lag screw was first screwed up into the compression hole on the PHILOS plate,the crossing suture wires were tightened up to resist the rotator cuff stress and maintain the internal inclination of the humeral head.Kirschner wires were used to temporarily stabilize the reduction.After satisfactory reduction and fine plate positions were confirmed by fluoroscopy,locking nails were screwed up.The internal inclination of the affected humeral head was compared between preoperation and the last follow-up.The therapeutic efficacy was evaluated by the shoulder Neer scoring system,and the visual analogue scale(VAS)pain scores and complications were recorded at the last follow-up.Results All the 30 patients were followed for 6 to 18 months(average,12 months).There was no incision infection,neurovascular injury,or internal fixation failure.Anatomical reduction was achieved in 25 patients and functional reduction in 5.The inclination of the humeral head was significantly improved.The VAS scores at the last follow-up averaged 1.9.Follow-up X-ray examination showed that bony union was achieved after 6 to 18 months(average,9 months)for all patients.At the last follow-up,the inclination angle of the affected humeral head was 130°±5°,significantly improved compared with the preoperative 90°±11.2°(P<0.05).All patients had good functional recovery of the shoulder.The efficacy was,according to the Neer shoulder scores at the last follow-up,excellent in 22,good in 6 and fair in 2 cases.Conclusions Treatment of proximal humeral fractures using PHILOS via MIPO technique is suitable for patients with osteoporotic fracture,and may lead to fine therapeutic efficacy.