AO肱骨近端内锁定系统治疗肱骨近端骨折24例  

Treatment of humeral proximal fractures with proximal humeral internal locking system in 24 patients

作　　者：闵晓晖[1] 饶志涛[1] 俞光荣[1] 袁锋[1] 王家骐[1] 王树青[1] 

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《同济大学学报（医学版）》2009年第2期99-103,共5页Journal of Tongji University(Medical Science)

摘　　要：目的总结应用AO肱骨近端内锁定系统（Philos）治疗肱骨近端骨折的方法及疗效。方法2007年1月至2008年2月间,使用Philos内固定治疗肱骨近端骨折24例,男7例,女17例,年龄31～74岁,平均61.2岁。根据Neer分型,二部分骨折6例,三部分骨折15例,四部分骨折3例,其中4例延伸至肱骨干中段骨折。手术采用三角肌、胸大肌间隙入路,不剥离附着于骨折碎片及大、小结节上的组织即行骨折复位固定,其中7例骨缺损行人工颗粒骨充填。术后第3天肩关节适量被动活动,1周后适量主动及被动活动,2周后加强主动及被动活动功能锻炼。结果21/24例（87.5%）获得随访,随访时间3～14个月,平均8.2个月,骨折均愈合,平均愈合时间11.5周（10～16周）。按Neer肩关节功能评分标准评定,优14例,良3例,满意4例,优良率81.0%（17/21）。结论Philos可起到牢固固定肱骨近端骨折的作用,骨折愈合与功能锻炼同步,提高了治疗效果,特别适用于肱骨近端骨质疏松性、粉碎性骨折及延伸至肱骨干的骨折。Objective To study the clinical effect of open reduction and internal fixation with proximal humeral internal locking system（Philos） on proximal humeral fractures.Methods Twenty-four cases of proximal humeral fractures treated with Philos from January 2007 to February 2008 were studied retrospectively,in which seven males and seventeen females with age of 31～74 years old（mean 61.2 years）.According to Neer classification,six cases were with two-part fractures,fifteen with three-part fractures and three cases with four-part fractures including four cases with fracture line extending to the middle of humerus.Reduction and fixation was done via deltopectoral-groove approach,without peeling the soft tissues of the greater and lesser tuberosity.Bone graft was applied for 7 cases.Shoulder exercise could be performed passively three days after operation.One week after operation,passive and active shoulder exercise was done,which was gradually intensified two weeks after operation.Results The follow up period was 3～14 months（mean 8.2 months） on 21 cases and it showed that all fractures were healed with average union period of 11.5 weeks（range,10 to 16 weeks）.According to Neer shoulder score,the results showed that fourteen cases were excellent,three cases were good and four were fair,with an excellence rate of 81.0%（17/21）.Conclusion Philos plate can firmly fixate the fractures.It simultaneously carries out fracture healing and function exercise and enhances the treatment effect.Philos plate is especially suitable for osteoporosis and comminuted proximal humeral fractures,also for the fracture line extending to the middle of humerus.

关 键 词：肩骨折 骨折固定术 内 肱骨近端锁定接骨板 PHILOS 

分 类 号：R681[医药卫生—骨科学]