微创锁定接骨板技术治疗复杂肱骨干骨折

目的探讨肱骨前方入路锁定钢板微创治疗复杂肱骨干骨折的疗效。方法2005年1月-2008年12月利用微创锁定接骨板技术治疗26例复杂肱骨干骨折（骨折类型采用AO分型标准：B型骨折15例,C型骨折11例）,采用闭合牵引复位,肱骨前侧微创切口,钢板经皮下潜行插入,跨越骨折端,钢板置于肱骨干前表面,经皮进行锁钉螺钉固定。UCLA标准评估肩关节功能。结果26例骨折术后3-5个月,平均4个月愈合。2例出现桡神经损害症状,分别于术后2周、3．5月内神经功能恢复;1例因钢板过高产生肩关节撞击症状,骨折愈合后内固定取出,症状消失。26例术后随访18-36个月,平均26个月,术后6个月肩关节功能UCLA评分优良率92．3％（24／26）。结论微创肱骨前方置人锁定钛板技术是治疗复杂性肱骨干骨折的一种安全有效的方法。     

微创经皮钢板内固定治疗肱骨中下段C型骨折

目的 探讨应用微创经皮钢板内固定技术(MIPPO)治疗肱骨中下段C型骨折的临床疗效.方法 对28例肱骨中下段C型骨折患者通过闭合牵引复位,经小切口插入锁定钢板(LCP),钢板置于肱骨前侧,一期内固定.术后分别以UCLA和Mayo评估肩、肘关节功能.结果 患者均获得随访,时间16～22个月.骨折均愈合,愈合时间3～5个月.1例出现伤口延迟愈合;1例出现桡神经损害症状;1例因钢板过高产生肩关节撞击症状.参照UCLA肩关节评分:优 12例,良 11例,差 5例;Mayo肘关节评分:优 6例,良 14例,可 6例,差 2例.结论 MIPPO技术治疗肱骨中下段C型骨折,临床效果良好.     

经前方入路微创锁定加压接骨板内固定治疗肱骨中下段螺旋形骨折

目的探讨锁定加压接骨板(LCP)经前方入路微创内固定技术(MIPO)治疗肱骨中下段螺旋形骨折的临床疗效。方法回顾分析2016年12月至2018年1月厦门大学附属成功医院骨科采用LCP经前方入路MIPO治疗的12例闭合性肱骨中下段螺旋形骨折患者资料。男8例,女4例;年龄18~38岁,平均21.8岁。按AO/OTA骨折分型:12-A1.2型5例,12-A1.3型2例,12-B1.2型2例,12-B1.3型2例,12-C1.1型1例。记录患者手术时间、术中出血量、术后早期并发症、骨折愈合时间;末次随访时采用美国加州大学洛杉矶分校(UCLA)肩关节评分标准评定肩关节功能,采用Mayo肘关节功能评分系统(MEPS)评定肘关节功能。结果手术时间为43~130 min,平均63 min;术中出血量为60~280 mL,平均139 mL。术后切口均一期愈合,未出现感染及医源性神经损伤等并发症。12例患者术后获10~21个月(平均13.7个月)随访。所有患者均获骨性愈合,愈合时间11~20周,平均15.8周。术后均未发生内固定物松动、断裂。末次随访时肩关节功能UCLA评分为31~35分,平均34.5分;肘关节功能MEPs评分为90~100分,平均99分。结论采用LCP经前方入路MIPO治疗肱骨中下段螺旋形骨折具有创伤小、神经损伤风险低、临床疗效满意的优点,是一种安全有效的肱骨微创内固定技术,值得临床推广。     

微创技术结合锁定钢板治疗老年骨质疏松性肱骨干骨折的临床疗效

目的:探讨微创技术结合锁定钢板治疗老年骨质疏松性肱骨干骨折的临床疗效。方法 :2012年7月至2016年12月,采用微创技术结合锁定钢板治疗26例老年骨质疏松性肱骨干骨折患者,男10例,女16例;年龄61～81岁,平均70.3岁;平均骨密度值-2.74。26例骨折均为闭合性骨折,其中A型6例,B型7例,C型13例。所有病例术后随访12个月,统计术前及术后12个月Constant肩关评分和Mayo肘关节评分。结果:26例均获随访,时间12～16个月,平均13.2个月,骨折均在16周内愈合,平均愈合时间14.3周。Constant肩关节评分术前及术后12个月分别为54.61±2.09、88.50±2.47;Mayo肘关节评分术前及术后12个月分别为58.19±2.74、90.30±2.16。结论:微创技术结合锁定钢板治疗老年骨质疏松性肱骨干骨折术后肩、肘关节功能恢复良好,是治疗老年骨质疏松性肱骨干骨折的有效方法。     

锁定加压接骨板微创固定治疗肱骨二或三部分骨折的初步报告

目的 探讨肱骨前方入路结合锁定加压接骨板微创治疗肱骨二或三部分骨折的疗效. 方法 2005年3月至2008年10月,经肱骨前方入路应用锁定加压钢板(LCP)或肱骨近端内固定系统(PHILOS)钢板微创治疗22例肱骨二或三部分骨折患者,男13例,女9例;年龄46～78岁,平均63.4岁);左侧7例,右侧14例.骨折类型:肱骨干骨折伴肱骨近端骨折11例,肱骨干骨折伴肱骨远端骨折8例,肱骨干骨折伴肱骨近端骨折及肩关节脱位2例,肱骨干骨折合并肱骨近端、远端骨折及肩关节脱位1例.其中2例术前伴桡神经损伤,急诊行桡神经探查后再复位固定骨折.记录手术时间及术中出血量.采用Neer肩关节评分标准及肘关节HSS评分标准分别对患者患侧肩关节和肘关节进行评分.结果 评价以1年为标准,其中1例患者术后随访不到1年,以随访终末时间为结点. 结果 22例患者的手术时间78～150 min,平均107.9 min;术中出血量110～450 mL,平均274 mL.20例术后获平均9.4个月(8～22个月)随访,2例失访.20例患者骨折均获愈合,愈合时间8～16周(平均11.5周).骨折端无移位,螺钉无松动、拔出及断钉发生.2例术前伴桡神经损伤患者,1例3 d后功能恢复,另1例4个月后功能恢复.肩关节功能按Neer评分标准评定:优12例,良5例,中3例,优良率为85.0%.肘关节功能按HSS评分标准评定:优16例,良4例,优良率100%. 结论 肱骨前方切口经皮置入锁定加压接骨板具有创伤小、不损伤腋神经及桡神经等优点,治疗肱骨二或三部分骨折可获得较理想的临床疗效.     

微创技术置入PHILOS钢板治疗肱骨干近端骨折

目的评价微创接骨板固定(MIPO)技术置入PHILOS(proximal humeral internal locking system)治疗肱骨干近端骨折的临床效果。方法自2008年11月~2009年8月,采用MIPO技术置入PHILOS钢板治疗23例肱骨干近端移位骨折。结果本组获随访6～17个月,平均11.3个月。X线片示22例于术后6个月内骨折达骨性愈合;1例因内固定松动发生延迟愈合,但无临床症状,于术后9个月骨折愈合,功能恢复至可。术后半年1例发生肩关节撞击征,取出内固定行功能锻炼后功能恢复至可。采用Constant-Murley评分方法评定疗效:优11例,良10例,可2例,优良率91.3%。结论采用MIPO技术置入PHILOS钢板治疗肱骨近端骨折是一种良好的方法,减少骨不连发生率,有利于肩关节早期功能恢复。     

锁定钢板系统在四肢骨折中的应用

目的 总结微创锁定钢板治疗四肢骨折的疗效.方法 2005年5月至2006年10月,分别采用微创内固定系统(less invasive stabilization system,LISS)与锁定加压钢板(locking compression plate,LCP)对64例70处四肢骨折进行治疗,男45例,女19例;年龄17-69岁,平均36.8岁;股骨远端骨折16例19处,胫骨近端骨折28例31处,胫骨远端骨折8例8处,肱骨近端骨折12例12处.50处股骨远端与胫骨近端骨折采用LISS固定,20处胫骨远端与肱骨近端骨折采用LCP同定.在影像增强器监视下先行闭合复位,复位满意后采用经皮微创接骨术于肌肉下骨膜外置入LISS或LCP,再次确认位置满意后通过导向器经皮拧入锁定螺钉.结果 随访时间4～22个月,平均8.8个月.全部伤口均一期愈合,无一例发生感染、骨折再移位、成角畸形或内固定失败等并发症.骨折临床愈合时间8～16周,平均12.3周.膝关节功能HSS评分70～95分,平均87.5分,ROM 90°～130°,平均122°;踝关节AOFAS评分82～95分,平均91.4分;肩关节功能Neer评分82～94分,平均90.6分.患肢功能均恢复良好.结论 微创技术结合锁定钢板治疗四肢骨折具有软组织创伤小、对骨骼血供影响小、骨折愈合快、手术感染率低、功能恢复好等优点.锁定钢板无须紧贴骨面即可获得可靠的固定,不易发生骨折冉移位或内固定松动.     

长PHILOS钢板结合MIPO技术治疗肱骨近端伴肱骨干骨折临床研究

目的总结应用长型肱骨近端内固定锁定钢板(PHILOS),经微创钢板内固定(MIPO)技术,即肩峰下前外侧经三角肌入路治疗肱骨近端伴肱骨干复杂骨折的临床疗效。方法 2007年3月至2009年12月,应用长型PHILOS结合MIPO技术治疗肱骨近端伴肱骨干复杂骨折18例。其中男11例,女7例;年龄28～69岁,平均58.5岁。均为新鲜闭合性骨折,受伤至手术时间5～10 d。肱骨近端骨折中Neer分型2部分骨折2例,3部分骨折12例,4部分骨折4例;肱骨干骨折中AO分型A1型3例,A2型1例,B1型5例,B2型2例,B3型3例,C1型2例,C3型2例。术后肩关节功能评价采用Neer评分,肘关节功能评价采用美国特种外科医院(HSS)评分。结果 18例患者均获随访,随访时间11～31个月,平均14.6个月。术后出现桡神经麻痹症状1例,12周内自行恢复;出现肩关节慢性轻度疼痛2例,予以对症治疗后逐渐缓解。术后12个月18例全部达骨性愈合,无退钉或内固定松动等并发症发生。按Neer评分,肩关节功能优7例,良9例,中2例,优良率为88.9%;按HSS评分,肘关节功能优16例,良2例,优良率为100%。结论长型PHILOS结合MIPO技术,具有血运破坏少、固定可靠、并发症少、满意率高等优点,是治疗肱骨近端伴肱骨干骨折的一种新方法。     

Minimally invasive plate osteosynthesis for humerus diaphyseal fractures

Background:

Minimally invasive plate osteosynthesis (MIPO) technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture.

Materials and Methods:

32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively.

Results:

Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22–70 years). Twenty-seven of the thirty-two patients (84.3%) had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70–120 minutes) and mean radiation exposure was 160.3 seconds (range: 100–220 seconds). The mean radiological fracture union time was 12.9 weeks (range: 10–20 weeks). Shoulder function was excellent in 27 cases (84.3%) and good in remaining 5 cases (15.6%) on the UCLA score. Elbow function was excellent in 26 cases (81.2%), good in 5 cases (15.6%), and fair in 1 case (3.1%) who had an associated olecranon fracture that was fixed by tension band wire in the same sitting.

Conclusion:

MIPO of the humerus gives good functional and cosmetic results and should be considered one of the management options in the treatment of humeral diaphyseal fractures.     

经皮微创锁定加压接骨板内固定治疗复杂性股骨远端骨折

目的 探讨经皮微创锁定加压接骨板（LCP）内固定治疗复杂性股骨远端骨折的临床疗效。方法应用经皮微创LCP内固定治疗20例股骨远端复杂性骨折患者。结果全部获得随访,时间12～24个月,所有患者均达骨性愈合,愈合时间12～24周。根据HSS评分：优14例,良4例,可2例。结论经皮微创LCP内固定治疗股骨远端复杂性骨折具有固定稳定,血运破坏少,恢复快等优点,是一种疗效较好的生物学固定方法。     

前方入路联合MIPO技术治疗肱骨干骨折的有效性和安全性

背景：由于术中广泛剥离、牵拉骨折周围软组织、影响骨折端血供,传统接骨板在治疗肱骨骨折有较高的骨不连发生率和医源性神经损伤发生率。 目的：探讨前方入路联合微创经皮接骨板内固定（MIPO）技术治疗肱骨干骨折的有效性和安全性。 方法：回顾性分析2010年1月至2012年12月收治的77例肱骨干骨折患者的临床资料。根据治疗方法分为MIPO组和对照组。MIPO组采用微创经皮接骨板置入技术进行骨折固定,对照组采用传统的切开复位内固定技术进行骨折固定。对两组患者的手术情况和术后功能恢复进行比较。 结果：两组患者手术顺利,MIPO组手术时间比对照组稍长,住院时间比对照组稍短,但两组间差异无统计学意义（P＞0.05）。MIPO组术中失血量、骨折愈合时间均显著少于对照组（P＜0.05）。末次随访时,MIPO组的肩、肘关节活动度和DASH评分均显著优于对照组（P＜0.05）。两组患者术后均无严重并发症发生。 结论：采用MIPO技术治疗肱骨干骨折具有微创、固定牢靠、并发症少、术后功能恢复迅速且良好等优点,应在肱骨干骨折治疗中推广使用。     

锁定接骨板治疗老年肱骨近端骨折

目的 探讨肱骨近端锁定接骨板(LPHP)治疗肱骨近端骨折的临床疗效。方法 采PHP治疗29例肱骨近端骨折，按Neer分类法，二部分骨折11例；三部分骨折12例；四部分骨折6例。结果 平均愈合时间7．4周(6～12周)：按照Constant评分标准，功能优18例，良为8例，中为3例，优良率为89．6％。结论 肱骨近端锁定接骨板治疗眩骨近端骨折手术简单、固定可靠、并发症少、骨折愈合率高特别是老年骨质疏松患者首选治疗方法。     

Modified use of a proximal humeral internal locking system (PHILOS) plate in extra-articular distal-third diaphyseal humeral fractures

BackgroundSurgical treatment of extra-articular distal-third diaphyseal humeral fractures is controversial in terms of surgical approach and position of implant. The aim of this study is to evaluate the clinical and radiological outcomes of a modified application of the proximal humeral internal locking system (PHILOS) plate in extra-articular distal-third diaphyseal humeral fractures.Materials and methodsA total of 23 patients with extra-articular distal humerus fractures were treated using either open plating or the minimally invasive plate osteosynthesis (MIPO) technique with upside down application of the PHILOS plate. Fracture configuration, number of screws in the distal fragment, and time to union were analysed. Elbow range of motion, Mayo Elbow Performance Score (MEPS), and complications were evaluated at the final follow-up.ResultsFracture union was obtained in all patients at a mean postoperative time of 20.8 ± 2.9 weeks. The mean shortest and longest cortical lengths were 50.7 ± 14.0 mm and 85.2 ± 12.4 mm, respectively. The average number of screws in the distal humeral fragment was 5.6 ± 0.7. No statistically significant correlation was observed between the shortest cortical length and number of screws in the distal fragment (p = 0.224) or between the longest cortical length and the number of screws in the distal humeral fragment (p = 0.956). The average MEPS was 97.6 (range, 75–100). No postoperative complications that required reoperation were occured.ConclusionA modified anterior application of the PHILOS plate in extra-articular distal-third diaphyseal humeral fracture showed satisfactory outcomes, so it is an alternative when considering the ability to increase plate-screw density with locking screw fixation in a distal humeral fragment.Level of evidenceTherapeutic level IV, case series.     

经皮微创接骨板技术与髓内钉固定治疗肱骨干骨折的疗效比较

目的 比较经皮微创接骨板(MIPO)技术与髓内钉(IMN)固定技术治疗肱骨干骨折的临床效果.方法 回顾性分析2007年3月至2009年1月收治的52例肱骨干中下段骨折患者临床资料,分别采用闭合复位MIPO内固定(MIPO组)与顺行IMN固定(IMN组).MIPO组27例,男15例,女12例;年龄18～65岁,平均36.7岁;IMN组25例,男16例,女9例;年龄25～63岁,平均39.4岁.记录两组患者手术时间、术中出血量、骨折愈合时间、并发症、肘关节Mayo评分及肩关节Constant评分.结果 所有患者获16～36个月(平均17.8个月)随访.两组患者在手术时间、术中出血量、住院天数、骨折愈合时间及肘关节Mayo评分比较差异均无统计学意义(P>0.05).MIPO组术后无骨不连与桡神经麻痹等并发症发生;IMN组术后4例发生骨不连,2例出现桡神经麻痹,1例出现内翻畸形,但功能良好.MIPO组患者骨不连发生率低于IMN组,肩关节Constant评分高于IMN组,差异均有统计学意义(P<0.05).结论 MIPO微创内固定技术治疗肱骨干骨折具有创伤小、术中出血量少、骨性愈合快、肩肘功能恢复好等优点,同时能减少医源性桡神经损伤的风险.

Abstract：

Objective To compare clinical outcomes of minimally invasive plating osteosynthesis (MIPO) and intramedullary nail stabilization in treatment of acute humeral shaft fractures. Methods From March 2007 to January 2009, 52 patients were treated in our department for acute fractures of middle and lower humeral shaft. Twenty-seven were treated with MIPO technique (group A) and 25 with intramedullary nail (group B) . In group A, there were 15 men and 12 women, aged from 18 to 65 years (average, 36. 7 years); in group B, there were 16 men and 9 women, aged from 25 to 63 years (average,39. 4 years). Operation time, amount of blood transfusion, hospital stay, time for union, complications, Mayo scores of the elbow and Constant scores of the shoulder were recorded in both groups and compared statistically. Results The mean follow-up time was 17. 8 months (range, 16 to 36 months) . There were no significant differences between the 2 groups in operation time, amount of blood transfusion, hospital stay, time for union, and Mayo scores of the elbow ( P > 0. 05) . There was no case of postoperative iatrogenic radial nerve palsy or non-union in group A, but there were 4 cases of non-union, 2 cases of iatrogenic radial nerve palsy and one case of varus malunion in group B. Compared with group B, group A showed significant advantages in rate of postoperative non-union and Constant scores of the shoulder functional recovery ( P < 0. 05) . Conclusion In treatment of humeral shaft fractures, MIPO technique has advantages of less operative invasion, quick bone union, satisfactory shoulder functional recovery and low risk of postoperative palsy of the iatrogenic radial nerve.     

锁定加压钢板微创固定治疗肱骨干骨折的初步报告

目的探讨锁定加压钢板(LCP)经肱骨前侧入路微创穿皮固定治疗肱骨干骨折的方法及疗效。方法2004年2月-2005年1月间,使用LCP经肱骨前侧入路微创穿皮固定治疗肱骨干骨折17例,男12例,女5例;年龄18-75岁(平均48岁)。根据AO分型:A型3例,B型10例,C型4例。结果经14-25个月(平均19．1个月)随访,17例患者全部愈合。骨折愈合时间为9-14周(平均11．3周)。末次随访时,肩关节前屈135°-180°(平均174°),后伸20°-40°(平均38°),外展70°-90°(平均87°);肘关节前屈115°-135°(平均133°),后伸-10°-0°(平均-1°);手臂肩残疾问卷表(DASH)评分6-44分(平均11分)。术后3例出现并发症:1例GustiloⅢB型开放性骨折发生浅表感染,经保守治疗后痊愈;1例术后出现一过性桡神经麻痹,3个月后症状完全消退;另有1例出现明显的肩肘关节功能障碍。无继发骨折移位及内固定物失效或断裂。结论LCP经肱骨前侧入路微创穿皮固定治疗肱骨干骨折可以提供稳定的固定,骨折愈合率较高,神经血管结构相对安全;更适合于粉碎性或骨质较差的肱骨干骨折。     

MIPPO技术治疗四肢骨折

目的探讨BO原则下应用MIPPO技术治疗四肢骨折的方法和临床效果。方法60例四肢骨折患者均采用AO微创钢板稳定系统治疗,其中使用LCP钢板41例,LISS钢板12例,LPHP钢板7例。结果59例患者切口一期愈合,1例发生感染。全部获随访,时间12～19个月,骨折均骨性愈合,时间5～6个月;有3例10个月后出现钢板螺钉松动现象,无钢板断裂出现。患者功能恢复良好。结论MIPPO钢板具有创伤小,并发症少,骨愈合率高等优点,有着传统钢板无法比拟的优势。     

Intramedullary nailing of humeral shaft fractures with a locking flexible nail

BACKGROUND: Studies on intramedullary nailing of humeral shaft fractures in the orthopaedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of a new flexible, locking intramedullary nail that can be implanted in the humerus in either a retrograde or an antegrade manner without violating the rotator cuff mechanism or damaging the articular surface of the humeral head. METHODS: Fifty consecutive patients with fifty-one humeral shaft fractures were entered into our prospective clinical outcome study. The fracture was classified on the basis of the anatomic location and pattern. Implant positioning and fracture alignment were assessed postoperatively. Complications were recorded, and the time to union was measured. Shoulder function was evaluated with use of a combination of the Constant shoulder score, Short Form-36 (SF-36) clinical outcome data, range-of-motion measurements, and a subjective pain-rating scale. RESULTS: Forty-one patients with forty-two fractures had an adequate duration of clinical follow-up (a mean of twenty-two months) for analysis. Thirty-nine fractures healed, with a mean time to clinical union of twelve weeks (range, four to fifty weeks). Thirty-eight of the forty-two shoulders had minimal or no pain. Thirty-six shoulders had a full range of motion. The mean Constant shoulder score was 90 points. Four patients had five complications, which included two nonunions, two hardware failures, and one wound infection. All four patients had been managed with a 7.5-mm nail. A multivariate analysis demonstrated that an age of more than fifty years was associated with a lower Constant score and that the occurrence of a complication was associated with a lower physical component score on the SF-36. CONCLUSIONS: The flexible humeral nail allows both retrograde and antegrade implantation and static locking. Nail insertion can be accomplished without violating the rotator cuff or damaging the articular surface of the humeral head. Although the nail functioned well in most of our patients, the use of a small-diameter (7.5-mm) nail was associated with a higher complication rate. This implant should be used with caution in any patient with a medullary canal diameter of 相似文献   

内侧支撑螺钉在锁定钢板治疗肱骨近端骨折中的应用

目的 评估内侧支撑螺钉(medial support screw,MSS)对锁定钢板治疗肱骨近端骨折疗效的影响.方法 2006年6月至2009年11月,我院采用锁定钢板治疗肱骨近端骨折68例,并将其分为2组:-MSS组39例,仅以锁定钢板固定;+MSS组共29例,除以锁定钢板固定外还使用内侧支撑螺钉.应用统计学方法评价两组术后的影像学指标和肩关节功能.结果 术后随访3～12个月,平均7.4个月.所有骨折均愈合,平均愈合时间为5.6个月.+MSS组和-MSS组中分别发生内固定失效1例和9例,差异有统计学意义(P=0.036),所有内固定失效均出现在术后12周内.2组的丢失角度差异有统计学意义(P=0.049),而肱骨头内翻发生率差异无统计学意义(P=0.216).根据Constant肩关节评分标准评定:+MSS组和-MSS组的优良率分别为79%和62%,2组的评分差异有统计学意义(P=0.01).结论 锁定钢板在治疗肱骨近端骨折中可获得满意的疗效.在治疗肱骨近端骨折时,另以内侧支撑螺钉在肱骨头内下方获得支撑,可有效地维持骨折复位,增加骨折固定的稳定性.     

Antegrade locked nailing for humeral shaft fractures

Treatment results of antegrade locked nailing of acute humeral shaft fractures, including union rate and recovery of shoulder function, have been inconsistent. This led the current authors to hypothesize that implant design and surgical techniques might account for this inconsistency. In the current study, 47 fractures (38 acute; nine pathologic) in 47 patients achieved union with the techniques of closed nailing, short to long segment nailing, and fracture compression. Satisfactory recovery of shoulder function occurred because of minimal surgical trauma, prevention of impingement by the nail or locking screws, and prevention of axillary nerve injury or comminution of the humeral head. Forty-seven patients with 38 acute fractures and nine pathologic fractures were treated with humeral locked nails. Mean followup time was 21.4 months. With a single operation, all 38 acute fractures proceeded to eventual union; the average time to union was 7.8 weeks. Thirty-five patients had excellent or satisfactory recovery of shoulder function. Complications included slipout of the proximal screw, nail breakage, fragment displacement, and transient postoperative radial nerve palsy. All nine patients with pathologic fractures had substantial pain relief and increased arm function after surgery. The current study shows the reliability of antegrade locked nailing for proximal and middle third fractures of the humeral shaft.     

PHILOS 接骨板治疗复杂肱骨干中上段骨折的初步报告

目的 评价肱骨近端内固定锁定系统(PHILOS)接骨板治疗复杂肱骨干中上段骨折的临床疗效.方法 2007年4月至2008年1月,应用PHILOS接骨板治疗复杂肱骨干中上段骨折16例,男6例,女10例;年龄54～88岁,平均71.5岁;左侧11例,右侧5例;按AO/OTA分型:CI型4例,C2型3例,C3型9例.术中记录手术总时间,PHILOS接骨板置放时间,术中出血量.采用Constant-Murley肩关节评分标准,对患者健侧、患侧肩关节进行评分,同时计算患侧评分占健侧评分的百分比,＞80%为优良.60%～80%为满意,＜60%为差.结果 手术总时间为75～160 min,平均115 min;PHILOS接骨板置放时间25～45 min,平均35 min;术中出血量为150～525 ml,平均350 ml;住院时间为17～22 d,平均18.5 d.14例患者获得随访,随访时间5～12个月,平均9.6个月.骨折愈合时间7～16周,平均12.1周.骨折端无移位,螺钉无松动、拔出及断钉,患侧肱骨头较健侧无吸收、缩小征象;患侧肩关节前届上举活动度为120°～170°,平均150°.末次随访时Constant-Murley评分平均为78.5分(62～92分);患侧评分占健侧评分的百分比为75.6%～97.6%,平均87.6%;优良12例,满意2例,优良率为85.7%.结论 应用长型PHILOS锁定加压接骨板治疗复杂肱骨干中上段骨折可获得较理想的临床疗效.