PHILOS钢板治疗肱骨近端骨折早期内固定失效原因

doi:10.3969/j.issn.1671-167X.2016.04.023

摘要/Abstract

摘要：

目的：分析应用PHILOS锁定钢板治疗肱骨近端骨折术后早期内固定失效的原因。方法：对2010年11月至2014年11月采用PHILOS锁定钢板治疗的117例肱骨近端骨折进行回顾，术后4周内出现内固定失效8例，对其原因进行分析。结果：本组117例患者，共有8例发生术后早期内固定失效，占全部治疗病例的6.83%。8例患者平均年龄72.4岁，右侧3例,左侧5例；Neer分型2部分骨折3例,3部分骨折5例；内固定完全失效3例，部分失效5例；1例发生于术后第6天，7例发生于术后2~4周。完全失效的3例全部进行了二次手术，取出内固定物，其余5例部分失效的患者采取保守治疗，最终畸形愈合。结论：锁定钢板治疗肱骨近端骨折术后早期内固定失效与术中复位不良、内侧支撑不良、内固定自身缺陷、骨质疏松及术后康复措施不当有关。

关键词: 肱骨骨折, 骨折固定术, 内, 治疗失败

Abstract:

Objective：To analyze the reasons of early failure of the PHILOS in proximal humerus fractures. Methods:From Nov. 2010 to Nov. 2014, there were 117 patients with humerus fractures treated with PHILOS locking plate in Department of Orthopaedics, Xuanwu Hospital. All of the patients were treated with the plate by open reduction internal fixation, and we analyzed these cases retrospectively. After the operation, we removed the drainage tube within 48 h, and the patients were allowed to do the passive motion 3 days after the surgery if the X-Ray showed the plate and screws were reliable. Eight cases failed within 4 weeks after the operation. We analyzed the reasons of the failure. Results: The rate of the failed cases was 6.83%(8/117). The average age was 72.4(66-82) years. In the 8 failed cases, 3 were on the right side, and the other 5 on the left side. As for the reason of the fractures, 2 cases were because of car accidents, and the other 6 because of daily life injury. According to the Neer classification, 3 cases were 2-part fractures, and the other 5 3-part fractures. Three cases were total failure, and the other 5 partial failure. All the 8 failed cases failed within 4 weeks after the operation, of which 1 was on the sixth day after surgery, the other 7 2 to 4 weeks after the surgery.The 3 totally failed cases were treated by removing the screws and plates, the other 5 by conservative methods. All of the cases were malunion at the end.Conclusion: The early failure of the PHILOS locking plate in proximal humerus fractures is related to the bad reduction during the operation, the loss of medial cortex support, the limitation of screw length, the osteoporosis and the improper rehabilitation after operation.It is very important to do good preoperative plan for a surgeon. During the operation, we should try our best in the fracture reduction, use the appropriate plate and screws, and then pay attention to the rehabilitation after the operation. After all of this, the rate of failure may be decreased.

Key words: Humeral fractures, Fracture fixation, internal, Treatment failure

中图分类号:

武京伟，沈惠良，刘利民，高志华. PHILOS钢板治疗肱骨近端骨折早期内固定失效原因[J]. 北京大学学报(医学版), 2016, 48(4): 683-685.

WU Jing-wei, SHEN Hui-liang, LIU Li-min, GAO Zhi-hua. Analysis of early failure of the PHILOS in proximal humerus fractures[J]. Journal of Peking University(Health Sciences), 2016, 48(4): 683-685.

参考文献

相关文章 15

[1]	李伟浩,李伟,张学民,李清乐,焦洋,张韬,蒋京军,张小明. 去分支杂交手术和传统手术治疗胸腹主动脉瘤的结果比较[J]. 北京大学学报（医学版）, 2022, 54(1): 177-181.
[2]	牛占岳,薛艳,张静,张贺军,丁士刚. 胃腺瘤性息肉的内镜和病理特点及癌变的危险因素分析[J]. 北京大学学报（医学版）, 2021, 53(6): 1122-1127.
[3]	白鹏,王涛,周阳,陶立元,李刚,李正迁,郭向阳. 不同转流标准对颈动脉内膜切除术后脑梗死的影响[J]. 北京大学学报（医学版）, 2021, 53(6): 1144-1151.
[4]	庄金满,李天润,李选,栾景源,王昌明,冯琦琛,韩金涛. Rotarex经皮机械性血栓切除装置在急性下肢缺血中的应用[J]. 北京大学学报（医学版）, 2021, 53(6): 1159-1162.
[5]	周伟,安金刚,荣起国,张益. 下颌骨颏部骨折联合双侧髁突囊内骨折致伤机制的三维有限元分析[J]. 北京大学学报（医学版）, 2021, 53(5): 983-989.
[6]	敖明昕,李学民,于媛媛,时会娟,黄红拾,敖英芳,王薇. 视觉重建对老年人行走动态足底压力的影响[J]. 北京大学学报（医学版）, 2021, 53(5): 907-914.
[7]	庄金满,李天润,李选,栾景源,王昌明,冯琦琛,韩金涛. Rotarex 旋切导管在下肢动脉硬化闭塞症支架内再狭窄中的应用[J]. 北京大学学报（医学版）, 2021, 53(4): 740-743.
[8]	越雷,王月田,白纯碧,陈浩,付豪永,于峥嵘,李淳德,孙浩林. 内镜治疗中青年双节段腰椎间盘突出症患者的手术策略[J]. 北京大学学报（医学版）, 2021, 53(4): 734-739.
[9]	申杰, 杨迪, 陈梦圆, 郭新彪. 长度和化学修饰在多壁碳纳米管诱导内皮细胞活化中的作用[J]. 北京大学学报（医学版）, 2021, 53(3): 439-446.
[10]	黄丽东,宫玮玉,董艳梅. 生物活性玻璃对人脐静脉血管内皮细胞增殖及成血管的作用[J]. 北京大学学报（医学版）, 2021, 53(2): 371-377.
[11]	姜楠,包旭东,岳林. 全冠预备体终止线局部扫描正确度对整体的影响[J]. 北京大学学报（医学版）, 2021, 53(1): 102-108.
[12]	侯国进,周方,田耘,姬洪全,张志山,郭琰,吕扬,杨钟玮,张雅文. 后路短节段跨伤椎椎弓根螺钉固定治疗胸腰段爆裂骨折术后再发后凸的危险因素[J]. 北京大学学报（医学版）, 2021, 53(1): 167-174.
[13]	王迎春,黄永辉,常虹,姚炜,闫秀娥,李柯,张耀鹏,郑炜. 十二指肠乳头息肉良、恶性病变比较及活检准确性[J]. 北京大学学报（医学版）, 2021, 53(1): 204-209.
[14]	武颖超,蔡云龙,戎龙,张继新,刘金,汪欣. 早期胃癌淋巴结转移规律及内镜黏膜下剥离术治疗早期胃癌的疗效评价[J]. 北京大学学报（医学版）, 2020, 52(6): 1093-1097.
[15]	刘中砥,许庭珉,党育,张殿英,付中国. 有限切开复位髓内外联合固定技术治疗股骨转子下骨折的临床随访[J]. 北京大学学报（医学版）, 2020, 52(6): 1102-1106.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed