肱骨近端锁定加压接骨板内固定治疗肱骨近端三、四部分骨折

目的探讨应用肱骨近端锁定加压接骨板（lcking proximal humerus plate，LPHP）内固定治疗肱骨近端三、四部分骨折的方法及疗效。方法2003年7月-2005年1月，应用肱骨IPHP内固定治疗肱骨近端骨折13例，男6例，女7例；年龄27～74岁，平均49．8岁。根据Neer分型，三部分骨折5例，四部分骨折8例，其中骨质疏松6例。手术采用三角肌、胸大肌间隙入路，不切开关节囊，不剥离附着于骨折碎片及大、小结节上的组织即行骨折复位固定，其中骨缺损3例行同种异体骨植骨。术后第3天肩关节适量被动活动，1周后适量主动及被动活动，2周后加强主动及被动活动功能锻炼。结果12例获得随访，随访时间3～20个月，平均11个月，骨折均愈合。按Neer肩关节功能评分标准评定：优6例，良4例，满意2例，优良率83％。结论肱骨LPHP的螺钉能锁扣于接骨板上，接骨板不要求与骨皮质紧密相连即可起到骨折牢固固定作用，做到了骨折愈合与功能锻炼同步，提高了治疗效果，特别适用于肱骨近端三、四部分骨折及骨质疏松患者的治疗。

Locking proximal humerus plate for three- or four-part humeral proximal fractures

Objective To discuss the treatment effect of locking-proximal-humerus-plate (LPHP) for three- or four-part proximal humeral fractures. Methods A retrospective study was done on 13 cases of proximal humeral fractures treated with LPHP from July 2003 to January 2005. There were six males and seven females, with age of 24-73 years (mean 49.8 years). According to Neer classification, five cases were with three-part fractures and eight with four-part fractures including six cases with osteoporosis. Reduction and fixation was done via deltopectoral-groove approach, without cutting the capsule or peeling the soft tissues of the greater and lesser tuberosity. Of all, three cases with bone defects was treated with allografts. Shoulder exercise could be performed passively three days after operation. One week after operation, passive and active shoulder exercise was done, which was gradually intensified two weeks after operation. Results A follow up for 3-20 months (average 11 months) on 12 cases showed that all fractures were healed. According the Neer shoulder score, the results was excellent in six cases, good in four and fair in two, with excellence rate of 83.3%. Conclusions The screw of LPHP can lock the plate so that the plate can firmly fixate the fractures without tightly contacting the bone, as simultaneously reaches fracture healing and function exercise and enhances the treatment effect. LPHP is a specially suitable procedure for osteoporosis and three-or four-part proximal humeral fractures.