锁定钢板与普通钢板置入内固定修复肱骨近端骨折的预后对比

背景：肱骨近端骨折采用切开复位内固定的方法，对组织的损伤较大，对局部血运有明显损害，但是随着材料学的发展和修复技术的进步，并发症已明显下降。 目的：对比锁定钢板和普通钢板在肱骨近端骨折修复方面的差异。 方法：上海交通大学医学院附属同仁医院骨科自2012年2月至2014年10月收治移位较大及粉碎性肱骨近端骨折患者68例，根据内固定方案分为两组，锁定钢板组32例采用锁定钢板内固定，常规钢板组36例采用T型钢板、三叶草钢板内固定。治疗后第2，4，6，12，24周时在门诊进行随访，采用Neer评分系统评估肩关节功能治疗满意率。在内固定取出之前进行复查，观察患者并发症发生情况。 结果与结论：常规钢板组的治疗满意率明显低于锁定钢板组，差异有显著性意义(75%，81%，P < 0.05)。在并发症方面，锁定钢板组未发现断钉断板、肩缝撞击、肱骨头坏死及感染病例，发现疼痛者6例；常规钢板组发现断钉断板5例、肩缝撞击5例、疼痛者8例、肱骨头坏死2例、感染2例，常规钢板组治疗后并发症发生率显著高于锁定钢板组，差异有显著性意义(P < 0.05)。提示肱骨近端骨折的内固定材料应以锁定钢板作为首选，无论是修复满意度还是在修复后并发症方面，均优于常规内固定方法。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Prognosis of locking plate versus ordinary steel plate fixation for proximal humeral fractures

BACKGROUND:Proximal humeral fractures are commonly treated by open reduction and internal fixation, which greatly injuries tissue and noticeably damages local blood supply. However, with the development of material and progress of repair method, complications have obviously reduced. OBJECTIVE:To compare the difference of locking plate and ordinary steel plate in the repair of proximal humeral fractures. METHODS:A total of 68 patients with great displacement and comminuted proximal humeral fractures, who were treated in the Department of Orthopedics, Affiliated Tongren Hospital, Shanghai Jiao Tong University School of Medicine from February 2012 to October 2014, were enrolled in this study. According to fixation method, they were divided into two groups. 32 cases in the locking plate group were subjected to locking plate, and 36 cases in the ordinary steel plate group received fixation with T type plate and Clover plate. They were followed up at the out-patient clinic at 2, 4, 6, 12 and 24 weeks after treatment. The satisfaction rate of shoulder function treatment was assessed using Neer scoring system. They received reexamination before withdrawal of fixator. The incidence of complications was observed in patients. RESULTS AND CONCLUSION:The satisfaction rate was significantly lower in the ordinary steel plate group than in the locking plate group (75%, 81%, P < 0.05). No screw and plate breakage, shoulder seam impact, humeral head necrosis or infection was found in the locking plate group. Six cases suffered from pain. In the ordinary steel plate group, there were screw and plate breakage in five cases, shoulder seam impact in five cases, pain in eight cases, humeral head necrosis in two cases and infection in two cases. The incidence of complications was significantly greater in the ordinary steel plate group than in the locking plate group (P < 0.05). These data suggest that locking plate can be used as the first choice for internal fixation in treatment of proximal humeral fractures. No matter satisfaction rate of repair or complications, it is better than ordinary steel plate fixation.