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.

Fixation of complex middle-proximal humeral shaft fractures using the PHILOS plate: early experience

Objective To evaluate the clinical outcomes of the proximal humeral internal locking system (PHILOS) plate treating the complex middle-proximal humeral shaft fractures.Methods From April 2007 to January 2008,a total of 16 patients with acutely complex middle-proximal humeral shaft fractures were treated by open reduction and internal fixation using the PHILOS plate.There were 6 males and 10 females with an average age of 71.5 years (range,54-88 years),the left side was involved in 11 cases,and the right side was involved in 5 cases.According to AO/OTA classification,4 cases belonged to CI,3 to C2,and 9 to C3.The operative time,PHILOS plate insertion time and operative blood loss were recorded.Functional assessment was done using the Constant-Murley shoulder score and percentage Constant-Murley score,＞80% was excellent or good,60%-80% was satisfactory,and ＜ 60% was poor.Results The mean operative time was 115 min(range,75-160 min),PHILOS plate insertion time was 35 min(range,25-45 min),operative blood loss was 350 ml (range,150-525 ml) and hospitalization time was 18.5 d (range,17-22 d).In 14 patients,the mean follow-up time was 9.6 months (range,5-12 months).The mean fractures healing time was 12.1 weeks (range,7-16 weeks).No complications were found,such as delayed union and nonunion,displaced,avascular necrosis,cutout or backout of the screws and plates.The mean ROM of the shoulders was 150°(range,120°-170°).The Constant-Murley score of the injury side was mean 78.5 (range,62-92) at the final follow-up,which was 87.6% (range,75.6%-97.6%) of the Constant-Murley score of normal side.The clinical outcomes were excellent or good in 12 cases(85.7%),satisfactory in 2 eases.Conclusion According to our experience,the PHILOS plate design provides stable fixation with a good functional outcome for the complex middle-proximal humeral shaft fractures and eliminates most hardware problems and complications.