LPHP和PHILOS治疗老年肱骨近端复杂骨折疗效对比分析
摘要
目的：
比较使用不同的内固定材料(LPHP和PHILOS)治疗老年肱骨近端三、四部分骨折的临床疗效,探求老年肱骨近端复杂骨折的最佳治疗方案。
方法：
回顾性分析2009年6月至2011年3月我院肱骨近端三、四部分骨折老年患者的临床资料,排除影响骨折愈合的疾病(如糖尿病等)、神经损伤病例,共80例。根据Neer分类,肱骨近端三部分骨折52例,肱骨近端四部分骨折28例。根据其分别使用LPHP和PHILOS作为内固定材料分为两组,其中LPHP组43例(肱骨近端三部分骨折28例,肱骨近端四部分骨折15例),PHILOS组37例(肱骨近端三部分骨折24例,肱骨近端四部分骨折13例)。经统计学检验后,组间患者年龄、性别、吸烟史、受伤机制均无显著差异。术后比较两组病例手术时间、术中出血量、术后疼痛情况、骨折愈合时间、Neer肩关节功能评分。
结果：
两组80例患者获得3-12个月,平均随访10个月。手术时间、术中出血量及Neer评分差异无统计学意义,PHILOS组术后疼痛比例低于LPHP组患者,且骨折愈合时间少于后者。两组均无畸形愈合,无内固定失效,无血管神经损伤,无肱骨头缺血坏死。
结论：
使用PHILOS和LPHP治疗老年肱骨近端复杂骨折疗效良好,但PHILOS在减少骨折愈合时间及术后疼痛方面优于LPHP。
Objective
To investigate the outcomes of different locking proximal humerus plate (LPHP and PHILOS) by deltoid split approach for treatmentof three and four-part proximal humeral fracture.
Materials and methods
Eighty patients with proximal humeral fractures were treated with the two locking proximal humerus plate by deltoid split from Juny2009to March2011. There are all complexproximal humerus fractures,three-part(n=52), four-part(n=28) fractures according to the neer classification, according to their respectively using LPHP or PHILOS were divided into two groups. Do functional exercises early after operativation.Have the X-ray egularly and have their follow-up in three month.half an yeah and one year later.
Results
All of them received3-12months, an average of10months follow-up. Operation time and Neer score were no significant difference between the two groups. The proportion of postoperative pain is lower in the group of PHILOS than that of the group of LPHP. There were no complications related to the implant included loosening or breakage of the plate, infection,axillaryparesis, vascularinjury,humeral headnecrosisandredislocationof the fracture.
Conclusions
The using of PHILOS and LPHP in the treatment of complex fractures of proximal humerus curative effect is good, but PHILOS in reducing the healing time and postoperative pain is better than LPHP.
比较使用不同的内固定材料(LPHP和PHILOS)治疗老年肱骨近端三、四部分骨折的临床疗效,探求老年肱骨近端复杂骨折的最佳治疗方案。
方法：
回顾性分析2009年6月至2011年3月我院肱骨近端三、四部分骨折老年患者的临床资料,排除影响骨折愈合的疾病(如糖尿病等)、神经损伤病例,共80例。根据Neer分类,肱骨近端三部分骨折52例,肱骨近端四部分骨折28例。根据其分别使用LPHP和PHILOS作为内固定材料分为两组,其中LPHP组43例(肱骨近端三部分骨折28例,肱骨近端四部分骨折15例),PHILOS组37例(肱骨近端三部分骨折24例,肱骨近端四部分骨折13例)。经统计学检验后,组间患者年龄、性别、吸烟史、受伤机制均无显著差异。术后比较两组病例手术时间、术中出血量、术后疼痛情况、骨折愈合时间、Neer肩关节功能评分。
结果：
两组80例患者获得3-12个月,平均随访10个月。手术时间、术中出血量及Neer评分差异无统计学意义,PHILOS组术后疼痛比例低于LPHP组患者,且骨折愈合时间少于后者。两组均无畸形愈合,无内固定失效,无血管神经损伤,无肱骨头缺血坏死。
结论：
使用PHILOS和LPHP治疗老年肱骨近端复杂骨折疗效良好,但PHILOS在减少骨折愈合时间及术后疼痛方面优于LPHP。
Objective
To investigate the outcomes of different locking proximal humerus plate (LPHP and PHILOS) by deltoid split approach for treatmentof three and four-part proximal humeral fracture.
Materials and methods
Eighty patients with proximal humeral fractures were treated with the two locking proximal humerus plate by deltoid split from Juny2009to March2011. There are all complexproximal humerus fractures,three-part(n=52), four-part(n=28) fractures according to the neer classification, according to their respectively using LPHP or PHILOS were divided into two groups. Do functional exercises early after operativation.Have the X-ray egularly and have their follow-up in three month.half an yeah and one year later.
Results
All of them received3-12months, an average of10months follow-up. Operation time and Neer score were no significant difference between the two groups. The proportion of postoperative pain is lower in the group of PHILOS than that of the group of LPHP. There were no complications related to the implant included loosening or breakage of the plate, infection,axillaryparesis, vascularinjury,humeral headnecrosisandredislocationof the fracture.
Conclusions
The using of PHILOS and LPHP in the treatment of complex fractures of proximal humerus curative effect is good, but PHILOS in reducing the healing time and postoperative pain is better than LPHP.
引文
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[4]ZinggU, Brunnschweiler D, Keller H, et a.l Percutaneousminimal osteosynthesisof fractures of the proximal humerus in elderly pa-tientsSwissSurg, 2002,8(1):11-14
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[11]WarnerJP,CostourosJG Fracturesofthe proximalhumerus. rockwood & green'S fracturesin adults.6thed. Philadelphia:Lippincott Williams&Wilkins.2006, 1170-1193.
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[14]姜春岩.如何正确理解肱骨近端骨折的Neer分型[C].第三届中国国际骨科学术会议.北京：北京大学第三医院,2009
[15]McLaurinTM.Proximal humerusfractures inthe el-derly are we operationontoo many [J]. ull HospJt Dis,2004,62(1-2):24-32.
[16]刘皤.关于老年人肱骨近端骨折手术方式选择的探讨[J].中华外科杂志,2006,44(4)：279～281
[17]杨铁毅,张岩,刘树义,等.锁定钢板微创固定治疗老年肱骨近端骨折[J].中国骨与关节损伤杂志,2008,23(5)：402
[18]刘德荣,梁加利,陆耀刚.微创技术植入锁定加压钢板治疗肱骨干近端骨折[J].中国修复重建外科杂志,2009,23(11)：1282-1284
[19]Gerhar d Konrad& Anja Hirsch muller& Laurent Audi ge & Simon Lam bert & Ralf Hert el & Norbe rt P. Sudka mp Received:25 October 2011/Accepted:1 November 2011#Springer-Verlag 2011
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