锁定钢板内固定治疗肱骨近端骨折的临床应用价值［摘要］目的探讨青壮年高能量创伤和老年人骨疏松性肱骨近端严重移位复杂骨折的新方法，方法对我院2008年元月至2010年元月，采用锁定钢板内固定治疗肱骨近端骨折32例，术前均行计算机X线摄影(DR)片检查，部分骨折严重，移位骨块不确定方位的患者行CT检查。采用标准肩关节前外侧切口，经胸大肌和三角肌肌间沟入路，伴肩关节脱位者将肱骨头复位，再将骨折复位,骨缺损或老年患者因骨质疏松骨折时造成空洞，采用自体骨或人工骨填塞支撑，用锁定钢板固定,C臂X线机透视证明骨折对位对线好，修复关节囊及肩袖损伤。结果本组患者切口均一期愈合,无医源性损伤，随访29例，随访时间8〜18个月，X线片示骨折对位对线良好,骨折愈合良好，愈合时间6~12个月。按Neer评分［2］结果:优23例占79.31%,良5例占17.24%,可1例占3.45%,总优良率96.55%。结论适合肱骨近端特殊的解剖形态，肱骨头固定螺钉向不同的方向交叉设计,提高了内固定物抗拔出力，特别适合于骨质疏松的老年患者;有较好的锚合力和较高的抗拉力，可防止螺钉退出和内固定松动，对肱骨头的支持固定较英它如A0型及普通接骨板得到明显的加强，尤其是对粉碎性骨折,老年患者骨质疏松及其植骨患者良好的稳定固定作用。体积小,板较薄，操作减少对软组织的剥离和刺激，降低了肩峰撞击症的发生率，总之锁定钢板技术的提出和应用可以在最大程度上保护骨端的血运并达到稳定的固定,促进骨痂愈合［2］。由于肱骨近端锁定钢板能青壮年高能量创伤和对老年骨质疏松性骨折的骨折块提供确切的固定，人工关节置换术的适应症已经明显缩小［3］。［关键词］肱骨骨折;锁定钢板；内固定;治疗［中图分类号JR683.41［文献标识码］A［文章编号］1005-0515(2010)-7-0491-02TheClinicalApplicationValueofLockingPlateInternalFixationinTreatingFractureofProximalHumerusLiGonglunWangGuoruiLongPingZhaoHun(TheSecondSurgicalDepartmentofNo.478MilitaryHospital,KunMing650200,china)[Abstract]ObjectiveToexplorethenewmethodfortreatingseveredisplacementandcomplicatedfractureofproximalhumeruscausedbyhighenergytraumainyoungadultsandosteoporosisintheelderly.Methods32casesofproximalhumerusfractureweretreatedwithlockingplateinternalfixationfromJan2008toJan2010andexaminedbyX-rayradiography(DR)beforeoperation.CTexaminationswereperformedonsomepatientswithseverefractureanduncertaindisplacementorientationofbones・Standardanterolateralincisionofshoulderjointwasadoptedbyinterscaleneapproachbetweenpectoralismajoranddeltoid・Theheadofhumeruswasrepositionedfirstinpatientswithshoulderjointdislocationandthenthefracture・Autogenousorartificialbonewasusedtofillthecavitycausedbybonedefectorosteoporosisintheelderly,andthelockingplatewasusedforfixation.DamagedarticularcapsuleandrotatorcuffwererepairedaftergoodalignmentwasshownbyC-brachialX-raymachine・ResultsThepatientsofthisgroupallgainedprimaryhealingwithoutiatrogenicinjuries・29caseswerefollowedupfor8-18months・X-rayradiographydemonstratedgoodalignmentandfracturehealing・Thehealingtimewas6-12months・AccordingtotheNeerscoring[1]result,therewere23casesofexcellenceaccountingfor79.31%,5weregoodaccountingfor17.24%,and1notbadaccountingfor3.45%・Thetotalrateofgoodandabovegoodwas96.55%・ConclusionsThesetscrewsofhumerusaredesignedascrossingindifferentdirectionsaccordingtothespecialanatomicalformofproximalhumerustoimproveanti-pulloutforceofinternalfixation,whichisespeciallysuitablefortheoldpatientsofosteoporosis;thelockingplatehasbetteranchorjointforceandstretchingresistancetopreventscrewdroppingandlooseningoftheinternalfixation,whichmakeitenjoyabettersecuringeffectcomparingwithotherkindsofboneplatessuchasAOtypeespeciallyforpatientswithc...