目的 探讨采用长型肱骨近端锁定钢板(PHILOS)扭转塑形经前方入路插入治疗肱骨近端伴肱骨干骨折的临床疗效.方法 2013年1月至2017年1月应用长型PHILOS扭转后经前方插入治疗肱骨近端伴肱骨干骨折22例,均为新鲜闭合骨折,不伴桡神经损伤,受伤至手术时间2~10d.肱骨近端骨折按Neer分型:二部分骨折15例、三部分骨折7例.肱骨干骨折按AO分型:A1型6例、A2型8例、B1型3例、B2型5例.采用Neer评分评价术后肩关节功能.结果 22例均获随访,时间11~24个月,平均(15±3.3)个月.骨折全部愈合时间2~5个月,平均(3±1.3)个月,未发生骨折不愈合、内固定松动等并发症.术后出现桡神经麻痹症状1例,给予神经营养药物后4个月内恢复正常;肩关节慢性疼痛2例,予对症治疗后缓解.按Neer评分:优16例、良4例、可1例、差1例,优良率90.9%.结论 长型PHILOS结合MIPPO技术治疗肱骨近端伴肱骨干骨折,软组织损伤小、固定牢靠,能有效避免桡神经损伤,值得临床推广.%Objective To evaluate the surgical treatment and clinic outcome of percutaneous fixation with precontoured long PHILOS locking compression plate on the proximal humerus fractures and humeral shaft fractures. Methods There were 22 patients of acute proximal humerus fractures and humeral shaft fractures without radial nerve injury were surgical treated by per percutaneous fixation with precontoured long PHILOS locking compression plate from January 2013 to January 2017.The interval from injury to operation was 2~10 days. According to the Neer classification,type Ⅱ (n=15)and type Ⅲ(n=7).All the fractures on humeral shaft were classified by AO/OTA as type A1(n=6),type A2(n=8),type B1(n=3), type B2(n=5). Functional outcome of shoulder was assessed using the Neer scoring system. Results All patients were followed up for operation, the follow up time was 11~24(15±3.3)months. Fractures had healed from 2~5(3±1.3)months. One patient had transient symptom of radial nerve paralysis,which disappeared within 4 months. No complications such as fracture ununion or internal fixator loosening. Sixteen cases were graded as excellent,4 as good,1 as fair,and the excellent and good rate was 90.9% according to Neer scoring system. Conclutions Long PHILOS combined with MIPPO technique in the treatment of proximal humerus fractures with humeral shaft,soft tissue injury is small,firm fixation,can effectively avoid radial nerve injury,worthy of clinical promotion.
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