Percutaneous plate and anatomical locking plate fixation for the treatment of proximal humeral fractures

doi:10.3969/j.issn.2095-4344.2013.30.024

Abstract

Abstract:

BACKGROUND: For the patients with proximal humeral fractures or serious complications, internal fixation is the effective method that cannot influence the activity of the shoulder with few trauma.
OBJECTIVE: To investigate the biomechanical characteristics of percutaneous plate combined with anatomical locking plate fixation for the treatment of proximal humeral fractures.
METHODS: Seventy-five patients with proximal humeral fractures were selected from Department of Orthopedics, the Third Affiliated Hospital of Guangzhou Medical University between March 2007 and December 2011. The healing after the locking plate fixation and the shoulder joint score after internal fixation were observed. The biomechanical advantages of locking plate fixation in the treatment of proximal humeral fractures were analyzed.
RESUTLS AND CONCLUSION: All the 75 patients were followed up for 6-24 months, average 13.3 months. The X-ray film after treatment showed all the screws were in correct position with satisfactory fracture reduction, and the fractures were healed without neurovascular injury and humeral head necrosis; one case had infection and healed after treatment, 72 cases had no shoulder pain, while three cases had occasional shoulder pain. The Neer score was excellent in 57 cases, good in 11 cases, moderate in seven cases and poor in none, and the excellent and good rate was 90.7%. Compared with other fixation implants, the locking plate fixation in the treatment of proximal humeral fractures has the advantages of high fixation strength and satisfactory effect, becoming the first choice for the clinical treatment of proximal humeral fractures.

Key words: bone and joint implants, academic discussion of bone and joint, minimally invasive percutaneous plate, anatomical locking plate, internal fixation, proximal humeral fractures, biomechanics, Neer score

CLC Number:

R318

Qiu Qin-ye, Hu Han-sheng, Fan Zhen-bo, Li Sui, Zhang Hua-huan, Yu Sheng-hua, Yang Zhan-xiang, Li Yuan-hui, Yin De-long . Percutaneous plate and anatomical locking plate fixation for the treatment of proximal humeral fractures [J]. Chinese Journal of Tissue Engineering Research, 2013, 17(30): 5569-5574.

Figures/Tables 3

2.1 相关研究资料的获取采用检索CNKI数据库的方法获取[1]。 2.2 资料检索方式检索时间范围2003至2012年，检索词为“微创钢板；解剖锁定钢板；内固定；肱骨近端骨折”，共检索相关文献67篇，学术期刊数据库文献58篇，硕士学位论文数据库文献2篇，中国会议论文数据库文献7篇。最终纳入分析的文献共8篇[2-9]。入选标准：①检索结果中，其内容与锁定钢板治疗肱骨近端骨折有关，排除与研究目的不相关的文献以及护理内容的文献。②检索文献体例为论著和病例报告等，均为一次性文献，综述为前人的经验和目前研究进展的文献，排除综述类文献。③同一作者的相似和重复研究，只选取其中1篇纳入分析。④纳入不同内固定物治疗肱骨近端骨折的生物力学分析研究文献。⑤纳入比较经皮微创钢板与传统方法治疗肱骨近端骨折后的关节功能恢复研究的文献。 2.3 不同内固定物治疗肱骨近端骨折的生物力学分析吴焯鹏等[2]分析肱骨近端复杂骨折4种内固定方法的力学特征，分别用交叉克氏针加螺钉、解剖钢板、Ender氏针加张力带、近端锁定钢板来固定，对各组标本进行压缩试验和拉伸试验，结果见表1。陈强等[3]应用足部X形AO锁定钢板治疗19例肱骨大结节骨折患者，对锁定钢板的生物力学进行分析。所有患者均为闭合性损伤且骨折移位均>5 mm，其中11例伴肩关节前脱位，受伤到治疗时间为2-5 d，平均3.5 d。对治疗骨折愈合、肩关节Constant评分和并发症等进行随访研究。发现Constant评分为(90.6±4.0)分(77-95分)，其中优16例(84.2%)，良2例(10.5%)，中1例(5.3%)，差0例，优良率达94.7%。所有患者前举平均 155°(140°-170°)；侧方外展抬肩150°(130°-160°)；水平位外旋平均 52°(40°-70°)；水平位内旋平均 70°(50°-90°)。11例大结节骨折伴肩关节脱位者均未发生再次脱位，所有患者均无切口感染、局部皮肤麻木、肩峰下撞击、骨不愈合、大结节再移位、内固定松动等并发症。可见，足部X形AO锁定钢板治疗单纯肱骨大结节骨折可获得满意的疗效，具有血供破坏少、骨折固定稳定和早期活动等优点。"

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