PHILOS板联合异体腓骨内支撑治疗内侧柱支撑缺失的肱骨近端骨折

PHILOS plate combined with allogenic fibula internal support for proximal humerus fractures without medial column support

目的探讨PHILOS板联合异体腓骨内支撑治疗内侧柱支撑缺失的肱骨近端骨折的临床效果。方法回顾性分析我科2020年6月至2022年6月收治的24例单侧内侧柱支撑缺失的肱骨近端骨折患者的临床资料,均采用PHILOS板内固定联合异体腓骨内支撑治疗。记录手术时间、骨折愈合时间、并发症情况。末次随访时采用视觉模拟评分(VAS)评估肩关节疼痛程度,采用Constant-Murley评分评价肩关节功能。结果本组24例患者均顺利完成手术,手术时间平均(51.6±4.3)min。术后复查X线及CT示骨折复位满意,内固定器及异体腓骨位置良好。所有患者切口均一期愈合,无血管、神经损伤,无异体腓骨排异反应。24例患者均获得随访,随访时间12~24个月,平均(16.7±2.4)个月。骨折均愈合,愈合时间10~15周,平均(12.1±2.3)周。无肱骨头内翻塌陷及坏死,亦未出现内固定失效。末次随访时VAS评分平均(1.1±0.6)分,肩关节功能Constant-Murley评分平均(75.1±5.0)分,其中优20例,良4例,优良率为100%。结论采用PHILOS板联合异体腓骨内支撑治疗内侧柱支撑缺失的肱骨近端骨折,术中复位快,能重建并维持稳定的内侧柱支撑,减少肱骨头内翻塌陷、坏死及内固定失效的风险,术后疗效满意。

Objective To evaluate the clinical efficacy of internal fixation of PHILOS plate combined with allogenic fibula internal support in the treatment of proximal humerus fractures without medial column support.Methods The clinical data of 24 patients with proximal humerus fractures with unilateral medial column support loss from June 2020 to June 2022 were analyzed retrospectively.All cases were treated by internal fixation of PHILOS plate combined with allogenic fibula internal support.The operation time,healing time of fracture and complications were recorded.At the last follow-up,shoulder pain was assessed by visual analogue scale(VAS),and shoulder function was by Constant-Murley score(CMS).Results All the 24 patients completed the operation successfully with average operation time of 51.6±4.3 minutes.X-ray and CT showed the satisfactory fracture reduction,good position of internal fixation and allograft fibula were achieved after the operation.Primary healing of incision was achieved without vascular nerve injury or allogenic fibula rejection.24 patients were followed up for 12 to 24 months,with an average of 16.7±2.4 months.All fractures healed in 10 to 15 weeks(mean 12.1±2.3 weeks).There was no collapse and necrosis of humeral head and failure of internal fixation.VAS score was 1.1±0.6,and CMS score was 75.1±5.0 at the last follow-up.The shoulder function revealed that excellent in 20 cases,good in 4 cases,and the fineness rate was 100%.Conclusion Internal fixation of PHILOS plate combined with allogenic fibular internal support can achieve rapid fracture reduction,reconstruct stable medial column support,and reduce the risk of collapse and necrosis of humeral head and internal fixation failure,and it is an effect method for proximal humerus fractures with medial column support loss.