Management of Proximal Humeral Fractures with Proximal Humerus Locking Plate—A Prospective Study: 以肱骨近端鎖定鋼板治療近端肱骨骨折—個前瞻性的研究

BackgroundDisplaced proximal humeral fractures, which used to be treated conservatively in the past, often had compromised functional results. With the advancement of technology, these fractures are now more often managed operatively, fulfilling the demands of an active and productive life style by the patients. The aim of this study was to assess the functional outcome of management of proximal humeral fractures with Philos (Synthes; Johnson and Johnson, West Chester, Pennsylvania, USA) plate fixation.MethodsIn this prospective study, 40 patients aged 18–80 years (mean age 52.4 years) with fractures of the proximal humerus, including two-, three-, and four-part fractures, were treated by open reduction internal fixation with Philos plating. Patients were functionally evaluated based on subjective (35 points) and objective (65 points) parameters as per the constant scoring system.ResultsAll these operated patients were followed up for 18–36 months (average 27.3 months). Functional outcome based on the constant scoring system showed excellent results in 20 (50%), good in eight (20%), and moderate in eight (20%) patients. Four (10%) patients had poor functional results. Out of six cases of four-part fracture dislocations, avascular necrosis of the humeral head was observed in two patients. One of these two patients had avascular necrosis of the head along with nonunion of the fragment to the shaft.ConclusionPhilos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and minimal complications.

中文摘要背景移位性近端肱骨骨折，從前多採用保守性的治療，往往引致功能缺失的結果。現在因為技術日漸進步，這些骨折經常以手術作治療，從而達到更佳的效果和使患者能享受更活躍的生活。這個研究的目的是評估以PHILOS (Synthes，強生公司，美國) 鎖定鋼板內固定治療近端肱骨骨折後其功能康復的結果。方法在這個前瞻性研究中有40例，其年齡從18歲至80歲（平均年齡52.4歲）。他們患有兩部分、三部分和四部分肱骨近端骨折，全以手術開放性復位並Philos鎖定鋼板內固定作治療方法。患者的功能以Constant得分（CS）系統的主觀（35分）和客觀（65分）參數作評估。結果所有患者在手術後進行隨訪18-36個月（平均27.3個月） 。基於Constant得分（CS）系統功能的評估，其結果為優有20例（ 50％），良8例（20％）和可8例（20％）。四患者（10％）為功能效果不佳。在6例四部分近端肱骨骨折脫位中，有兩名患者有肱骨頭缺血性壞死（AVN）。其中之一例其肱骨頭缺血性壞死更延伸至未癒合的肱骨幹。結論Philos鎖定鋼板內固定術對治療肱骨近端骨折，提供了一個穩定的固定方法，其併發症少且有良好的功能效果。