Zhao Ji-Peng, Hu Wan-Kun, Zhang Qiu-Lin, Lin Jian, Zhou Qian, He Jian-Jun, Zhuge Tian-Yu
Department of Orthopaedics, Boai Hospital of Taizhou, Zhejiang, China.
Zhongguo Gu Shang. 2012 Feb;25(2):155-7.
To study clinical effects of PHILOS (proximal humeral internal locking system) plates through mini-open deltoid-splitting approach for the treatment of proximal humeral fractures.
From March 2006 to August 2010, 22 patients with proximal humeral fractures were treated with PHILOS plates through mini-open deltoid-splitting approach. According to Neer classification, 6 cases were type II, 15 cases were type III and 1 case was type IV. Through the anterolateral approach to the shoulder, anterolateral vertical incision of 4 cm length was perforrmed from 1 cm under acromion, and separated deltoideus muscle vertically to touch the fracture,reduced the end of fracture directly and indirectly. PHILOS plate was inserted downward into anterolateral surface of humerus through deltoideus muscle, the distal end and proximal end was fixed by locking screws. The Neer score for shoulder function was evaluated within 1 year after operation.
The operative time ranged from 30 to 70 minutes with an average of 45 minutes. No blood transfusion was required during the operation, and all incisions healed in stage I. All the patients were followed up, and the duration ranged from 6 to 18 months with a mean time of 12.5 months. All the fractures healed up perfectly, and the union time ranged from 6 to 12 weeks. According to Neer criteria for shoulder joint function, 10 patients got an excellent result, 9 good, 2 poor and 1 bad. There were no complications such as axillary nerve injuries, screw loosening, steel plate breakage, dislocation of shoulder joint and necrosis of humeral bone.
PHILOS plate through mini-open deltoid-splittin approach for the treatment of proximal humeral fractures has follow advantages: simple recover,minor-injuries and small tissue invasion, which is an ideal method to treat proximal humeral fractures.
研究采用经三角肌劈开小切口入路应用PHILOS（肱骨近端锁定系统）钢板治疗肱骨近端骨折的临床疗效。
2006年3月至2010年8月，对22例肱骨近端骨折患者采用经三角肌劈开小切口入路应用PHILOS钢板治疗。按Neer分型，Ⅱ型6例，Ⅲ型15例，Ⅳ型1例。经肩部前外侧入路，于肩峰下1 cm处做4 cm长的前外侧纵行切口，纵行劈开三角肌显露骨折，直接或间接复位骨折端。将PHILOS钢板经三角肌下插入肱骨前外侧，远近端用锁定螺钉固定。术后1年内采用Neer肩关节功能评分标准进行评价。
手术时间30～70分钟，平均45分钟。术中均未输血，切口均Ⅰ期愈合。全部患者均获随访，随访时间6～18个月，平均12.5个月。所有骨折均达骨性愈合，愈合时间6～12周。按Neer肩关节功能评定标准，优10例，良9例，可2例，差1例。无腋神经损伤、螺钉松动、钢板断裂、肩关节脱位及肱骨头坏死等并发症发生。
经三角肌劈开小切口入路应用PHILOS钢板治疗肱骨近端骨折具有复位简单、创伤小、组织侵袭少等优点，是治疗肱骨近端骨折的理想方法。
