PHILOS钢板治疗肱骨近端骨折早期内固定失效原因  

Analysis of early failure of the PHILOS in proximal humerus fractures

作　　者：武京伟[1] 沈惠良[1] 刘利民[1] 高志华[1] 

机构地区：[1]首都医科大学宣武医院骨科,北京100053

出　　处：《北京大学学报（医学版）》2016年第4期683-685,共3页Journal of Peking University:Health Sciences

摘　　要：目的：分析应用PHILOS锁定钢板治疗肱骨近端骨折术后早期内固定失效的原因。方法：对2010年11月至2014年11月采用PHILOS锁定钢板治疗的117例肱骨近端骨折进行回顾,术后4周内出现内固定失效8例,对其原因进行分析。结果：本组117例患者,共有8例发生术后早期内固定失效,占全部治疗病例的6.83%。8例患者平均年龄72.4岁,右侧3例,左侧5例;Neer分型2部分骨折3例,3部分骨折5例;内固定完全失效3例,部分失效5例;1例发生于术后第6天,7例发生于术后2~4周。完全失效的3例全部进行了二次手术,取出内固定物,其余5例部分失效的患者采取保守治疗,最终畸形愈合。结论：锁定钢板治疗肱骨近端骨折术后早期内固定失效与术中复位不良、内侧支撑不良、内固定自身缺陷、骨质疏松及术后康复措施不当有关。Objective：To analyze the reasons of early failure of the PHILOS in proximal humerus fractures. Methods：From Nov. 2010 to Nov. 2014, there were 117 patients with humerus fractures treated with PHILOS locking plate in Department of Orthopaedics, Xuanwu Hospital. All of the patients were treated with the plate by open reduction internal fixation, and we analyzed these cases retrospectively. After the operation, we removed the drainage tube within 48 h, and the patients were allowed to do the passive motion 3 days after the surgery if the X-Ray showed the plate and screws were reliable. Eight cases failed within 4 weeks after the operation. We analyzed the reasons of the failure. Results： The rate of the failed cases was 6.83% （8/117）. The average age was 72.4 （66 -82） years. In the 8 failed cases, 3 were on the right side, and the other 5 on the left side. As for the reason of the fractures, 2 cases were because of car accidents, and the other 6 because of daily life injury. According to the Neer classification, 3 cases were 2-part fractures, and the other 5 3-part fractures. Three cases were total failure, and the other 5 partial failure. All the 8 failed cases failed within 4 weeks after the operation, of which 1 was on the sixth day after surgery, the other 7 2 to 4 weeks after the surgery. The 3 totally failed cases were treated by removing the screws and plates, the other 5 by conservative methods. All of the cases were malunion at the end. Conclusion： The early failure of the PHILOS locking plate in proximal humerus fractures is related to the bad reduction during the operation, the loss of medial cortex support, the limitation of screw length, the osteoporosis and the improper rehabilitation after operation. It is very important to do good preoperative plan for a surgeon. During the operation, we should try our best in the fracture reduction, use the appropriate plate and screws, and then pay attention to the rehabilitation after the operation. After all of this, the rate of failure may be dec

关 键 词：肱骨骨折 骨折固定术 内 治疗失败 

分 类 号：R683.41[医药卫生—骨科学]