有限切开经三角肌入路肱骨近端锁定接骨板治疗肱骨近端骨折  

Application of PHILOS plate through mini-open deltoid-splitting approach for the treatment of proximal humeral fractures

作　　者：赵吉鹏 胡万坤[2] 张秋林[2] 林涧 周前 何建军 诸葛天瑜 

机构地区：[1]台州博爱医院骨科,浙江台州318050 [2]上海长海医院骨科

出　　处：《中国骨伤》2012年第2期155-157,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨有限切开经三角肌入路应用肱骨近端锁定接骨板(proximal humeral internallocking system,PHILOS)治疗肱骨近端骨折临床效果。方法:自2006年3月至2010年8月采用经肩峰下前外侧有限切开三角肌入路PHILOS钢板治疗22例肱骨近端骨折,Neer分型,Ⅱ型6例,Ⅲ型15例,Ⅳ型1例。经肩前外侧入路,于肩峰下1cm做前外侧纵行切口,长4cm,纵行分离三角肌,探及骨折,直接或间接复位骨折端。PHILOS钢板通过三角肌层下插至肱骨前外侧面,远近端锁定螺钉固定,观测术后1年Neer肩关节功能评分。结果:手术时间30～70min,平均45min。术中无须输血,切口均Ⅰ期愈合。22例均获随访,时间6～18个月,平均12.5个月,骨折全部愈合,愈合时间6～12周。根据Neer肩关节功能评分标准:优10例,良9例,可2例,差1例。无一例出现腋神经损伤、螺钉松动、钢板断裂、肩关节脱位以及肱骨头坏死。结论:有限切开经三角肌入路应用PHILOS钢板治疗肱骨近端骨折具有复位简洁、微创、组织侵袭小的优点,有利于术后早期功能锻炼,是治疗肱骨近端骨折理想的方法。Objective：To study clinical effects of PHILOS（proximal humeral internal locking system）plates through mini-open deltoid-splitting approach for the treatment of proximal humeral fractures. Methods：From March 2006 to August 2010,22 patients with proximal humeral fractures were treated with PHILOS plates through mini-open deltoid-splitting approach. According to Neer classification,6 cases were typeⅡ,15 cases were typeⅢ and 1 case was typeⅣ. Through the anterolateral approach to the shoulder,anterolateral vertical incision of 4 cm length was perforrmed from 1 cm under acromion,and separated deltoideus muscle vertically to touch the fracture,reduced the end of fracture directly and indirectly. PHILOS plate was inserted downward into anterolateral surface of humerus through deltoideus muscle,the distal end and proximal end was fixed by locking screws. The Neer score for shoulder function was evaluated within 1 year after operation. Results：The operative time ranged from 30 to 70 minutes with an average of 45 minutes. No blood transfusion was required during the operation,and all incisions healed in stage I. All the patients were followed up,and the duration ranged from 6 to 18 months with a mean time of 12.5 months. All the fractures healed up perfectly,and the union time ranged from 6 to 12 weeks. According to Neer criteria for shoulder joint function,10 patients got an excellent result,9 good,2 poor and 1 bad. There were no complications such as axillary nerve injuries,screw loosening,steel plate breakage,dislocation of shoulder joint and necrosis of humeral bone. Conclusion：PHILOS plate through mini-open deltoid-splittin approach for the treatment of proximal humeral fractures has follow advantages：simple recover,minor-injuries and small tissue invasion,which is an ideal method to treat proximal humeral fractures.

关 键 词：肱骨骨折 肩关节 骨折固定术 

分 类 号：R681.7[医药卫生—骨科学]